Given today’s climate, and the pressures of healthcare practices collecting on their fees, physician groups and professionals need to know how to effectively evaluate a billing company. Declining reimbursements, increased costs from complex regulations, and higher employee costs are just a few of the reasons why these groups should consider hiring a billing service or replacing their current one.
Here are three considerations to effectively evaluate a billing company:
1. Performance vs. Price
Billing services tend to reflect “you get what you pay for.” It’s easy to set up and operate a billing company that can handle simple tasks, but it’s a different thing altogether when looking for a highly optimized service that can achieve high levels of net collections, consistently. If a practice just focuses on the price, many factors – denial management, A/R management, patient payments – may be overlooked, directly impacting the practice’s revenue.
Therefore, it’s imperative for practices to look at both performance and price to determine its best interests. Companies might be able to find a low-cost service, but that usually means they have less investment in technology, training, and repeatable processes. To make sure you are collecting all the fees that are owed to you, you need to consider performance as a key driver in your decision-making.
2. Reporting and Dashboards
Another avenue to explore to effectively evaluate a billing company is reporting and dashboards. A few years ago, access to real-time data and information gave companies and practices a competitive advantage; now it’s standard just to stay in business. Today’s leading companies offer their clients robust advanced analytical reporting and “dashboards” showing practice performance at a glance plus the ability to drill down into details as needed. It’s important to ask to see the billing company’s standard monthly reporting package.
Along with “charges, adjustments, and payments,” these reports should also include summaries by payer, by location, and by physician. Additionally, being able to receive customized reports, and in the formats you need them in, would be ideal. Be sure you’re able to visualize the most important elements of your billing practices so that your practice can maximize its reimbursements.
A final way to effectively evaluate a billing company is to see how advanced their technology offerings are. Technology is what enables real-time data, so the incorporation and investment of emerging technologies like artificial intelligence (AI) and machine learning (ML) should be included in your billing company’s offerings.
You can read about the importance of AI in medical billing by reading our white paper, “Why AI Technologies Are Essential for Your Medical Billing.”
Given the constantly changing regulations and complexities within the industry, technology is imperative. It’s a huge advantage to deal with a company that has its own proprietary software and IT resources. Remaining independent of third-party services enables your practice to receive customized features, interfaces, implementations, and increases time management. Of course, the billing technology used by a billing company must be robust. The company should be experienced with front-end interfaces of all types, whether from a hospital ADT or ECC system, RIS, PACS, LIS, or EMR. Finally, make sure that they will be responsible for quickly and seamlessly integrating their technology into your current stack. Your business can’t afford any downtime, as that will directly impact on your revenue collection.
To learn more about best practices and how to evaluate a billing company, check out our “How to Evaluate a Billing Company” white paper, get in touch with an AdvantEdge expert, or stay up to date on company and industry trends by visiting our Linkedin page.
Being able to improve radiology billing is a priority for every practice to help maximize reimbursements, however, it gets more difficult every day for several reasons – insurance companies change their rules and parameters, patient costs and co-payments continue to rise, growing audits, etc.
With this in mind, here are 3 tips to help you improve your radiology billing:
It’s critical that office-based practices collect and verify patient demographics, including name, address, phone, social security number, insurance, guarantor, etc. every chance they get. To that extent, it’s important to effectively train employees to ask questions like:
An effective way to drill on the importance of collecting this information is to illustrate how much extra work is needed if any of the information is incorrect.
For hospital-based practices, scheduling periodic meetings with hospital executives is a good rule of thumb for capturing the demographics and making sure the data is complete.
Whether office or hospital-based, if technology is in place, insist on eligibility checking as early into the process as possible. Offices should do this after scheduling in order to see the patient status. Hospitals should perform these checks after registration.
Another way to improve radiology billing is to keep a close eye on the denials rate. While most claims are paid the first time they are filed, some are not – and that percentage can be a problem. By monitoring the denials rate, (or “first pass denial rate”), this indicates how effective a practice’s upfront process is and how well its billing edits and checks are performing.
As denials occur, it’s important to have processes in place for resolving them and submitting an appeal. Unfortunately, it’s frequent practice for billing staff to refile the claim, but this is not an effective process. Having this process in place is what separates good billing results from mediocre. A second denial measure is used to monitor the percentage of charges that are denied and never paid (percentage should be in the single digits).
Higher deductible insurance plans and co-pays are on the rise, putting more fiscal responsibility on patients. Not every dollar will be coming from insurance companies, so it’s important to closely monitor how much patients owe while “treating” patients with care. Here are some practical ideas:
Want to learn more about how to improve radiology billing? Download our “3 Tips to Improve Your Billing” white paper, get in touch with an AdvantEdge expert, or stay up to date on company and industry trends by visiting our LinkedIn page.
Now more than ever, maximizing medical billing reimbursement is critical for hospitals, private practices, and medical facilities. With COVID-19 cases still lingering, the widespread medical professional shortage due to the Great Resignation, and the No Surprises Act changing the landscape of patient care, medical billing professionals need to stay current and agile in making sure they are collecting every dollar owed.
Are you collecting every dollar owed? The best way to answer this question is by reviewing historical data (over the past 12 months or so) to determine your net collection rate, but this is very time-consuming and expensive – and pulls your professionals away from critical everyday work.
So let’s discuss some shortcuts that can help you maximize medical billing reimbursement for your practice.
Generally, after conducting an analysis, our AdvantEdge professionals determine that billing operations fall into one of these three categories:
The Definition and Importance of Well-defined Processes
When we talk about a “well-defined process,” we mean that a company has the major elements of an RCM cycle in place such as
For providers in the first category, which unfortunately reflect only a small percentage of how many traditional providers have operated in the past, only minor fine-tuning needs to be made to one or certain areas within their processes.
It’s important that employees not think of their position in a silo (nursing, scheduling, billing), but instead as a functional group. By interacting and communicating as a group, this enables team members to see the big picture and how each person fits in, which ultimately will solve billing inefficiencies.
Prioritize Your Processes
Maximizing medical billing reimbursement should reflect strong attention and dedication to maintaining and promoting these well-defined processes. Have a “this is how we do things around here” so that staff members understand and continually follow best practices. With that said, it’s also important to be open to improvements to the process.
For example, consider the process of a traditional private practice scheduling appointments. Historically, the process has been calling to book and remind patients of their upcoming appointments. However, the employee that handles scheduling has noticed their demographic includes a younger generation of patients that don’t like to talk on the phone, and only interact digitally. By voicing a tweak to create automated text or email notifications requiring a response, the practice could see a higher engagement and confirmation of appointment date/time.
This is a very simple example, but it indicates the attention to process while having the flexibility to make changes that ultimately benefits the practice and its collections.
Do you believe your company might fall into the second or third category? If so, we suggest you download our free eBook, “Are We Really Collecting Every Dollar We Are Entitled To?,” that provides insight into how to revive your processes so that you can achieve the top category.
To learn more about maximizing medical billing reimbursement, we invite you to get in touch with an AdvantEdge expert now, or stay up to date on company and industry trends by visiting our LinkedIn page.
It appears that being able to have a baby in a hospital may be at jeopardy in some locations as soon as next month.
The medical industry – especially hospitals – continues to be impacted by The Great Resignation – with some of the first services to go are birthing units.
AdvantEdge has been following the medical staffing shortage trend for nearly a year now, beginning with an article we published in June 2021 around how the labor shortage is hurting in-house billing operations.
Recent news has indicated that at least five hospitals across three states have begun scaling back services due to staffing shortages.
For example, in Wyoming, Memorial Hospital of Carbon County is ending labor and delivery services on June 15, which is spending more than $100,000 a week bringing in traveling nurses to take the place of a number of staff nurses that have quit. Another hospital in the state, South Lincoln Medical Center, will stop these services as well beginning June 1.
Also in Massachusetts, Beverly Hospital announced in May it will be closing its freestanding birth center in September. This is after the hospital stopped taking new birth center patients in March due to the staffing shortage.
Regarding this announcement, Mark Gendreau, MD, chief medical officer of Beverly Hospital, was quoted saying, “Based on ongoing staffing issues…we have determined that it is no longer possible to sustainably operate this program in the long term.”
Finally, Schenectady-based Ellis Medicine in New York also paused inpatient adolescent mental health services, effective May 2.
Bringing in talent has been a widespread issue since the start of the pandemic, and has gone even further to include professionals quitting their positions for a number of reasons. These are just the latest stories regarding hospital and healthcare worker shortages, and it’s anticipated that hospitals and medical facilities will continue to feel the strain of available workers. It will be interesting to see what other services and medical functions administrators will need to pause or cut to remain solvent.
After more than two years, the consequences of COVID-19 continue to knock on our doors with troubling new data day after day. Just as communities begin to ease their restrictions, another wave crushes the hope of a pandemic-free tomorrow.
Using data as an asset to fight against the virus and protect our communities, the Centers for Disease Control and Prevention (CDC) shares weekly insight and trends based on closely tracked data. In their May 13 release, they shared 9 findings all should consider to stay safe through this uncertainty.
Cases, Hospitalizations, & Death
Although all three of these areas of insight seem interconnected, and for most of this pandemic have been closely related, the data begins to show that they have been moving in divergent paths. This is especially true when comparing cases and hospitalizations to death rates.
In the seven-day averages, the rate of new cases increased 30.7% (from 64,863 to 84,778), and the trend remained consistent when analyzing the number of hospitalizations which experienced a 17.5% increase (from 2,238 to 2,629). The highest daily averages in the past 14 days were experienced in New York: 20 percent (2,755), California: 27 percent (1,725), Florida: 37 percent (1,750), Pennsylvania: 44 percent (1,324), and Texas: 7 percent (1,163). The CDC identified both rises as part of a gradual increase that has occurred over the last five consecutive weeks.
On the other hand, the average death toll has decreased 15.4% (from 322 to 273). But this of course does not take away from the approach of the tragic milestone of 1 million deaths brought by COVID-19.
The leading factor in the decline of infections, hospitalizations, and most importantly deaths is the growing vaccination rate across the United States. Although the CDC identified an 18% fall from the previous week, the overall numbers across the population are on the right path, especially considering the initial skepticism and hesitancy seen from some states and demographics. The U.S. is now at a 77.8% vaccination rate with about 258.3 million people having received at least one dose of the COVID-19 vaccine. Not far behind, the number of individuals who have taken both doses are at 66.3%. The rate of both the initial and secondary vaccine administration experienced an increase from the previous week.
Variants & Testing
As more individuals get tested, we should expect the number of detected variants to continue to rise as it is the natural progression of any virus as it fights to stay alive. The national testing rate has slightly declined in data collected by the CDC that analyzed the reports for the week of April 29, 2022 (down 4.6% from 783,008 to 746,765), yet the rate of individuals testing positive still experienced a rise of 1.98% (now at 9.1%) from the week prior.
A former commissioner of the FDA (Food and Drug Administration), Scott Gottlieb, MD, recently shared his thoughts on testing with CBS News stating, “I think that we’re dramatically undercounting cases” and “we’re probably only picking up one in seven or one in eight infections”. This jump in positivity while having a decreasing testing rate and low probability of accuracy can pose a threat as more individuals are likely infecting others without knowing. This feeds to the continuous cycle of wave after wave, variant after variant.
From the projections made for the week ending May 7, the CDC estimated that the BA.2 omicron subvariant would account for 56.4% of U.S. cases. Making up the other largest group, BA.2.12.1 accounts for 42.6% of cases. Other omicron sub variants account for the remaining cases.
In our third Employee Spotlight of 2022, we talked with Rick Brozovic about how he enjoys all parts of the job—including solving client issues at 3 a.m.
A 31-year health care industry veteran, Rick Brozovic is passionate about his job as Interface Director at AdvantEdge, where he’s been on staff since 2009. He oversees a staff of six, including an employee in Bangalore, India. His team is responsible for all the data that’s loaded and imported into the AdvantEdge system.
“We get file extracts and real time HL7 interfaces from hospitals in the form of demographic information, charges and reports that end up flowing into the interface database,” Rick says. The data is “very well secured and protected. It’s a big responsibility, and we take our jobs very seriously.”
Interestingly, an IT job wasn’t always in the cards for him. A native of Lombard, Illinois, a western suburb of Chicago, early on he thought he wanted to be a writer. “I dabbled in poetry and English literature, and liked authors like Percy Shelley and William Shakespeare,” he says.
However, while a student at Moraine Valley Community College, in Palos Hills, Illinois, he worked part-time at a cabinet factory where he met three other people who also held earlier ambitions to be writers that led them to full-time careers in the factory. That was a pivotal moment, he says. “I changed gears and learned computer science instead”.
Trading Books for Binary and Bits
After college, he joined Oberweis Securities, overseeing their Information Systems (IS) Department. From there he moved on to Tech Support and Development at System Software Associates in Chicago, Illinois – at the time the largest IBM midrange software company in the world.
Rick joined AdvantEdge through its acquisition of Physicians’ Service Center, where he was Director of IS. He led the migration of PSC’s medical billing database to a new software platform under AdvantEdge. Rick’s team was responsible for implementing Virtual Manager enhancements that originated from Lombard’s legacy system – things like specialized interfaces with a Robo-Calling vendor, automated Skip Tracing, Denial Management Reporting, and enhancements to the interface import engine. A few years after joining the Virtual Manager Development team, the Chief Information Officer at the time; Manny DaSilva, asked if he could take over Virtual Manager interfaces.
One of his favorite parts of the job is working with all the groups from AdvantEdge Operations, Client Management, and clients. “I’m a competitive person and I want to see the company succeed. Working with interfaces, the value to the company and our clients is very evident and it’s easy to see the fruits of our labor.”
Overcoming any issues that might arise from data formatting issues or setting up new clients just comes with the territory. “It’s two sides of the coin,” he says. “If something goes wrong at 3 a.m. in the morning on Sunday, we must act quickly to solve an issue such as one that could affect a client’s ability to bill. We have to get them up and running as quickly as possible.”
At the same time, he says, “It’s a very exciting job to be a part of. There’s always a lot going on.”
Rick isn’t always working. He recently relocated to Tulsa, Oklahoma, where he enjoys spending his free time with his two grandchildren. He also enjoys reading at least one or two books per month, and is actively involved in his church.
We’re four months into the No Surprises Act, which is best known for its payment transparency for patients. However, putting these regulations into practice – particularly providing good-faith estimates – is already a nightmare, states a number of compliance experts.
It’s well known that the healthcare industry is full of complex regulations, and Surprise Billing just makes things more “daunting” for healthcare providers, states experts.
Praised for tackling one of the primary issues for patients – being stuck with unexpected, usually high medical bills because they may have been unknowingly cared for by a medical professional that was out-of-network – the other side of the coin will leave medical professionals and compliance professionals hustling to remain in compliance with this new legislation.
Harvey Rochman, a Manatt professional services firm partner, has compared the No Surprises Act to a “small Affordable Care Act (ACA)” because there are a variety of lesser-known requirements of the bill that might come as a shock or will be extremely difficult to put in place.
Rochman continues, “If you had to single out one thing that is really the most complex and difficult…it’s the good-faith estimate.” According to the bill, a broad range of providers will be required to provide these estimates to its patients. For example, dermatologists, who don’t provide emergency services at hospitals, will be subject to provide good-faith estimates.
Additionally, providers will be under strict time constraints to provide these good-faith estimates to patients. In some cases, it might be one day after the procedure is scheduled. In other situations, providers will have three days to provide the estimate within 10 days of scheduling the procedure.
There’s also the issue of determining who the “convening provider” will be to provide the estimate – is it the hospital or the specific surgeon? The AHA drafted a letter to the CMS stating that putting these measures in place have been difficult for even the most seasoned and sophisticated hospitals; it’s extremely difficult to automate, and many estimates need to be tailored to each patient.
As we’re in the early stages of the No Surprises Act, compliance will continue to be an uphill battle for providers and hospitals, and will be very costly to those that are unable to achieve compliance. This is a developing story that AdvantEdge will be keeping a close eye on.
To learn more, connect with us on our LinkedIn page or contact us to speak with an AdvantEdge expert regarding your billing needs. Additionally, stay up-to-date on company and industry news by subscribing to our newsletter.
Minimizing anesthesiology denials (as well as denials for every specialty) is a constant goal for every billing professional. The unfortunate reality is that denials are a part of everyday life, and only add more complexity to a regulatory and compliance-heavy industry.
However, with proper workflows and processes in place, professionals can more quickly and efficiently resolve denials that directly impact cash flow and limit billing costs.
We previously tackled radiology claim denials – you can check out a few tips on how to limit these denials by reading our blog post, “Three Tips to Minimizing Radiology Claim Denials.”
Let’s take a look at some of the common issues along with some best practices on minimizing anesthesiology denials for your practice.
1. ‘Not Medically Necessary’ – Not Again!!
One of the most common denials we see in regards to anesthesiology is the ‘not medically necessary’ reason. These denials are fairly consistent between all major healthcare carriers, with the ‘MAC (monitored anesthesia care) denial’ being most commonly linked to these occurrences.
A MAC denial is commonly driven by the assumption that a surgical procedure provided a higher level of anesthesiological care than the required level of care detailed for that service.
Additionally, a claim linked with this denial can be caused by a lack of information or diagnosis; if the diagnosis on the claim does not clearly support the service, the claim will be denied. Also, the frequency of the claim might also cause a denial – for example, two cases in the same day will require an appeal.
Therefore, in order to ensure reimbursement, it’s critical to keep all necessary documentation regarding each service – such as:
These documents will help you prove medical necessity, increasing your chances of claims reprocessing and payment if initially denied.
2. Turning Out-of-network Services into In-network Claims
It’s very common in medical facilities for out-of-network anesthesiologists to perform anesthesia on patients. The issue is that it is normally discovered after the procedure or service that the provider was outside of the patient’s network, leaving that individual with high out-of-pocket expenses they’re responsible for paying. This oftentimes leaves the bill unpaid, or collecting the bare minimum for the service. Costs and payment transparency are now covered for patients in the No Surprises Act, which went into effect January 1, 2022. As a result, regulations will be changing, so we will be monitoring how this impacts billing as events progress.
While not technically a denial since this is more about attempting to collect high out-of-network fees, this is still one of the major issues for anesthesiologists’ RCM efforts. There is a provision that varies from payer to payer – whether it’s RAPS provision, PARE logic, RAPL policy – that enables out-of-network anesthesiologists to have their medical claims processed at a members’ in-network level of benefits.
In many cases, patients with a PPO plan will include out-of-network benefits; be sure to investigate this option for other plans as well. For patients with this provision, their financial responsibilities are lower, greatly improving the chances that they will meet their financial obligation so that the anesthesiologist can be made whole.
3. The Problem with Pre-authorization
A final tip for minimizing anesthesiology denials is realizing that pre-authorization is a common hurdle that you’ll need to deal with. Even though pre-authorization doesn’t really make sense for anesthesia billing, due to the fact that anesthesiologists are blind providers since the patients don’t select them specifically, surgeons will oftentimes require pre-auth. When that happens, commercial payers will deny claims because they don’t have a pre-auth#.
Unfortunately, there isn’t much that can be done to proactively handle these claims before they get denied, so it’s important to have a well-built accounts receivable team in order to deal with these denial trends. Additionally, having a good appeals process is critical for making sure these claims get reprocessed and paid as soon as possible.
Want to learn more about minimizing anesthesiology denials for your practice? Get in touch with an AdvantEdge expert now, or stay up to date on company and industry trends by visiting our LinkedIn page.
Over the last few years, it has become difficult for physicians to excel due to increasing practice costs, declining reimbursements, pandemic costs, etc. However, there are a number of opportunities that physicians can take over the next several years. Here is a list of some strategies you can consider:
Nurturing Provider-Patient Relationships
In the growly socially distanced reality we face, fostering a strong, transparent relationship with patients has become vital for the success of physicians, and that is not likely to change any time soon. Experts foresee joint-effort, value-based care to be the route to take going forward. This approach leverages outpatient environments where patients are more likely to benefit from lower costs, shorter wait times, and personalized services.
As we mentioned in our past newsletter article, Hospital vs Private Practice – A Shifting Trend for Physicians?, the main reason for the shift from hospital to private practice was the search for autonomy but now it’s also due to its rise as a growing source of profitability. Experts are saying that location will be a critical factor because there are many underserved communities, especially during the labor shortage we are currently facing. Physician practices can leverage their flexibility and adaptability to deliver the attention and services those patients need.
For the physicians who still remain hesitant to take on a self-owned practice, they can take on more leadership roles in their healthcare system. This allows them to anticipate and steer clear of the numerous roadblocks present in our healthcare system such as workforce shortages and increasing costs of care.
Another growth opportunity for physicians is cost transparency. A significant percentage of patients pay out of pocket expenses, so they are fairly price conscious. Therefore, transparency in costs of procedures. This raises the question of whether these patients really need expensive health insurance plans in the first place. Direct primary care has been a growing force that competes with the traditional third-party plans by offering periodic payments for a defined set of primary care services to their care provider instead of monthly health insurance premiums or copays.
Adopt New Healthcare Models
It is known that those who don’t adapt, perish. This applies greatly to the evolving healthcare landscape. Experts are urging physicians to adopt a hybrid format of their traditional practices in which they also incorporate “virtual care, home-based care, remote monitoring, point-of-care machine-learning based diagnostic capabilities and precision medicine personalization”. This digitalization and shift to a virtual world will only facilitate and strengthen the work of care providers.
Technological advancement has become one of the driving factors in the growth of outpatient care, one of the fastest growing sectors of healthcare. Advancements in virtual/remote care, imaging, and telehealth are just a few of the elements leading the change.
One example of the change technology has empowered this shift in care is the growth in development of arthroplasty procedures. Many arthroplasty surgeons have leveraged ambulatory surgery centers to perform outpatient arthroplasty procedures which lessens their financial pressures and allows for patients to be discharged quicker than ever before.
Not only are physicians able to deliver safer, more accurate methods of care, but technology also grants them, their teams, and patients greater convenience. And as visits become more technologically driven, costs will continue to drop while speed and overall efficiency increase; therefore, optimizing results of visit and clearing time for more patients to be seen, which will then improve the overall revenues of the practice.
We hope you enjoyed this list of top five growth opportunities for physicians. To learn more, connect with us on our LinkedIn page or contact us to speak with an AdvantEdge expert regarding your billing needs. Additionally, stay up-to-date on company and industry news by subscribing to our newsletter.
Recognizing anxiety can be very difficult, given the many pressures and stresses of daily life. However, with anxiety on the rise, it’s important for medical professionals to not only accurately diagnose this illness, but how to treat it as well.
More than 20 million U.S. adults and children are affected by anxiety every year, making it one of the most common psychiatric disorders. In the last two years, all forms of anxiety (as well as depression) rose sharply, with many experts blaming Covid and the ensuing lockdowns, which isolated people from their support groups.
According to the U.S. Census Bureau Household Pulse Survey data, the number of U.S. adults with symptoms of anxiety and depressive disorders increased nationwide during the summer of 2020 through February of 2021. The World Health Organization also just released a report showing how anxiety and depression increased 25 percent worldwide in the first year of the pandemic.
Recognizing anxiety, specifically by being able to differentiate between normal, stress-induced anxiety and Generalized Anxiety Disorder or GAD, is critically important. As defined by the Mayo Clinic, signs of GAD or common anxiety include symptoms starting with feeling nervous, restless or tense. More serious symptoms include a sense of impending danger, panic or doom, an increased heart rate, hyperventilation, sweating, trembling, feeling weak or tired, having trouble concentrating or obsessing over a present worry. Physical symptoms might include fatigue and insomnia to nausea and irritability.
In general, medical experts say when anxiety symptoms start interfering with one’s daily life, it’s time to seek treatment. Is anxiety so all-consuming in one’s life that it’s conflicting with one’s ability to attend school, work or have relationships with others? It might be time to seek treatment.
While a range of factors can contribute to anxiety, it’s important to have a doctor rule out medical causes for anxiety. Medical conditions linked to anxiety may include: brain tumors, hormones (thyroid problems), infectious diseases such as Lyme disease or Guillain-Barre Syndrome, vitamin deficiencies, neurological conditions, chronic diseases or pain, and drugs including over-the-counter. Even too much caffeine or withdrawal from it—can be a root cause of anxiety.
If a doctor finds no medical causes for one’s anxiety, it’s time to examine the three common causes, which the National Institute of Mental Health lists as:
First, family history plays an important role in diagnosing a genetic cause. By examining one’s brain chemistry, doctors can see if one’s neuropathways aren’t working well, which in turn might be disrupting one’s mood. And finally, environmental factors—such as an abusive family environment or lockdowns, can contribute to anxiety disorders and people feeling hopeless and overwhelmed.
Recognizing anxiety through a psychiatrist, psychologist, or clinical social worker is a good place to start. A common diagnosis is psychotherapy, one of a host of anti-anxiety medicines on the market, or a combination or the two. Cognitive behavioral therapy (CBT) is another popular type of therapy that’s been successful treating GAD, as it offers patients concrete anxiety prevention and coping strategies.
Medical billing professionals are taking advantage of tools and solutions that are positively impacting RCM in order to improve their clients’ bottom line. As more and more practices are putting dollars behind modernizing their infrastructure, read five ways technology is changing the medical billing landscape. Read More
Workplace Trends | 2 min read
More and more young physicians and medical professionals are shifting towards private practice and away from larger hospitals and institutions. Is this shift towards private practice independence here to stay, or just a trend? Read More
Healthcare Tech | 2 min read
Adopting technology is essential in every industry, especially healthcare. Learn why providers and staff need to embrace new digital technology to help them keep up with the pressing needs of hospitals and health systems. Read More
Talent Shortage | 2 min read
Hospitals and medical practices continue struggling to fill job vacancies in this tight labor market. It’s been reported that, during the hiring process, some healthcare workers didn’t take the job due to high housing costs. Read More
Radiology | 1 min read
A recent Medscape survey found that nearly half percent (49%) of radiologists are feeling burned out and cited a “lack of respect” from other industry professionals. Read More
In a Covid/post-Covid world, does in-house billing still work for your practice. Download our white paper to compare performance, costs, and security.
A recent Medscape survey found that nearly half percent (49%) of radiologists are feeling burned-out and cited a “lack of respect” from other industry professionals, such as colleagues, staff members, and administrators. These findings place the profession in the Top 10 (7th) among specialists experiencing workplace fatigue.
Other contributing factors towards radiologists feeling burned-out include:
The survey also found that female radiologists are having a harder time with workplace fatigue. The data notes that 65 percent of these respondents were female, compared to 44 percent male.
In an attempt to curb fatigue, radiologists have been taking part in common tactics such as meditation or other stress-relieving techniques (26 percent), reducing hours (21 percent), changing work settings (21 percent), or speaking with administration about “productivity pressure” (13 percent).
The online-based survey was taken by more than 13,000 physicians, including 300 radiologists, between June and September 2021.
If you are a Medscape subscriber, you can read the full report, “Medscape Radiologist Lifestyle, Happiness & Burnout Report 2022.”
The battle between hospital vs private practice continues as more and more physicians are considering shifting toward independence.
We have been seeing a notable shift from healthcare workers toward large hospital providers, but many physicians predict that this is only a temporary trend especially amongst younger physicians and surgeons.
These mavericks in healthcare often find themselves frustrated and hindered by the systems in larger organizations, leaving them to wonder what other opportunities are available for their ambitious, entrepreneurial aspirations.
One primary reason in the hospital vs private practice fight is physician benefits. Just as it is in many other fields, networking will be key for physicians to continue to advance and flourish professionally in the upcoming years.
As physicians make decisions for the benefit of their own career, they will have higher expectations from prospective employers.
Partnership and mentoring, competitive compensation, autonomy – these are just a few of the benefits private practices can and should leverage to win over professionals looking to explore new paths.
But the adaptations made to attract new physicians can come at a great cost.
Healthcare becomes more expensive by the day; therefore, providing benefits, salaries, etc. will require the practice to pressure their employees to not just meet bottom line financials but breakthrough and profit at higher rates continuously.
This can easily endanger their once sought out benefits due to physicians feeling as if they’re once again in the uncomfortable work environments they were fleeing in the first place. It will be a challenging balancing act, but one that private practices will master once an equilibrium of efficiency, financial prosperity, and welfare are found using the right practice management model.
Impact on Patients
The autonomy provided by private practice enables another great benefit: flexibility. Not only does this benefit the physician but it is also increasingly becoming a vital factor in delivering quality care.
These two factors (autonomy and flexibility) provided by the environment of a private practice enables professionals to focus and personalize the experience of each patient, strengthening the physician-patient relationship.
Setting optimal office hours and scheduling for sufficient time with patients subsequently provide a personal work-life balance that empowers physicians and their teams to deliver the best care possible.
The digitalization of healthcare will contribute to their success in doing so, and will bring patients even closer to their providers. Technology will also do away with the substantial gap when comparing the resources available to hospitals in comparison to private practices.
And overall, the digital connectivity between general and specialized providers will make the patient-provider experience seamless, effective, and fruitful.
Key Trends in Legislation, Workforce Shortages, Cybersecurity and More Will Impact the Future of Medical Billing
WARREN, NJ – March 23, 2022 – AdvantEdge Healthcare Solutions (“AdvantEdge”), a leading national medical billing company with comprehensive coding, practice management and revenue cycle management services, announced today its newest white paper, “How Healthcare Trends in 2021 Will Impact The Future of Medical Billing”.
Capturing insights from AdvantEdge and Health Prime executives, the white paper provides actionable insight into the major healthcare trends and issues of 2021 that will shape decision making across the healthcare industry in 2022.
Below are key highlights from the white paper that reflects updates made:
There are many elements that will be changing the medical billing landscape in 2022 based on the actions and initiatives of the previous year. Learn more about how Health Prime and AdvantEdge executives perceive the future of the healthcare landscape, and how that will directly impact medical billing needs. Download our “How Healthcare Trends in 2021 Will Impact the Future of Medical Billing” white paper for more.
About AdvantEdge Healthcare Solutions
AdvantEdge, a member of the Health Prime family of companies, is recognized as one of the top ten US medical billing companies providing billing, certified coding, and practice management services to healthcare providers nationwide. Our services substantially improve decision making, maximize financial performance, streamline operations, and eliminate compliance risks for our healthcare clients. To learn more about AdvantEdge, visit www.ahsrcm.com. Follow us on Twitter at @DoctorBilling and on LinkedIn.
About Health Prime
Health Prime is a medical practice optimization company that serves as a strategic partner for care organizations in today’s modern consumer healthcare market. The company empowers doctors to spend more time with patients and less time taking care of paperwork.
Created by physicians for physicians, the company offers a full line of management and optimization solutions and services for physicians, medical groups, and hospitals in the United States. To learn more about Health Prime, visit Home – Health Prime (hpiinc.com). Follow us on Health Prime | Facebook and on LinkedIn.
Technology has expanded what’s possible for nearly every industry, including the healthcare sector. Along with providing critical functionality to medical professionals as well as patients, medical billing professionals have taken advantage of tools and solutions that are positively impacting the revenue cycle management cycle in order to improve their clients’ bottom line.
As more and more hospitals, practices, and medical facilities are putting dollars behind modernizing their infrastructure, here are five ways technology is changing the medical billing landscape.
1. Shifting Public Perception on Emerging Technology
Anything new, especially technology-related, can be scary to pursue given the unknown, and difficult to implement since it isn’t common practice yet. When artificial intelligence (AI) and machine learning were first introduced into the mainstream, like most other industries, it was largely ignored in the medical field. However, in recent years, due to marketing, advertising, and technologists/ambassadors, public perception has become more accepting of its utilization.
Organizations and facilities are exploring how these technologies can benefit them, and are proactively searching it out. For example, the pandemic caused working from home policies to become more accepted, but before then business leaders were less likely to provide that. Now, as it’s more accepted throughout the world, a larger percentage of companies are offering this to its employees. Similar to the adoption of AI. Expect to see these types of services explode for medical professionals over the next few years.
2. The Pursuit to Automate (Almost) Everything
There is a lot of information and backend support that goes into medical claims and other workflows and processes that directly impact reimbursement for medical professionals. Medical billing companies are integrating AI and other next-gen solutions to automate as much of this process as possible in order to streamline activities and responsibilities. With automation in place, medical billing companies can provide efficiency, accuracy, and a competitive edge.
Consider the amount of data associated with medical billing. Through this AI evolution – taking tech cues from companies like Amazon, Google, Tesla – medical billing companies will be able to continue to apply transformative technology to the RCM cycle. Not only bringing actionable insights based on data, but keeping it uniform will accelerate much of what is still being manually performed. You can learn more about how AI can enable medical billing companies by reading our “Why AI Technologies Are Essential for Your Medical Billing Company” white paper.
3. Labor Shortage: Who’s Working on Claims?!
The Great Resignation is still alive and well, with the healthcare industry being one of the top 3 industries most affected. While the data doesn’t indicate the type of jobs people are quitting in this field, medical professionals are certainly feeling the strain on the administrative side with processing, finalizing, and collecting claims. This offers a unique opportunity for medical billing companies to step in and carry the load for facilities that traditionally have an in-house operation.
As physicians and other medical practices continue to serve its patients, all while dealing with legislation and regulations such as the No Surprises Act and Medicare cuts, it’s critical that they have a dedicated team that is handling the financial elements of the business. Medical professionals need constant efforts to increase their revenue stream.
4. The Patient Journey and the Trickle-down Effect
Automation is not only beneficial for medical professionals; it has trickled down to patients as well. With automation being able to streamline processes, documents, forms, etc., patients have a much more pleasant experience leading up to and following their appointments. With more access to the provider through integrated websites/applications and portals, patients can have all information completed and provided to their provider ahead of time.
Along with being able to handle their billing responsibilities, they can view previous lab results, schedule/reschedule appointments, and even communicate directly with their doctor. Technology continues to tear down the veil of separation that has been traditionally common between provider and patient. With technology, we’ll continue to see a more collaborative environment within healthcare.
5. The Freedom of Proprietary Software
The software that hospitals and professional medical facilities use is very important, especially within the medical billing world. It’s common for companies to use third-party software, but as these firms are requiring more specialized focus and treatment, enlisting the services of a company with proprietary software will continue to become commonplace.
For example, if a hospital is in need of customized systems or to interface with certain files, a proprietary solution would expedite that process because the medical billing company software has more flexibility, and customer service agents can work with backend support to make time-sensitive updates for the client. Given that software has become a critical element for helping business move forward, this will continue to be a more attractive solution for healthcare organizations.
Read our blog 5 Technology Questions for Medical Billing Companies to learn more about which tech questions can medical professionals make when evaluating medical billing companies.
Think about how your practice interacted with technology no more than five years ago, and how that has evolved to today. Technology in the medical billing space will evolve and iterate, helping billing and administrative professionals streamline their processes not only to capitalize on reimbursements, but to effect change for medical professionals and patients.
Do you have any thoughts on five ways technology is changing the medical billing landscape? Want to learn more about AdvantEdge, and how its innovative technology is pushing what’s possible for clients? Connect with us on our LinkedIn page or contact us to speak with an AdvantEdge expert about your needs.
In this Employee SPOTLIGHT, Joe Laden discusses what makes him gravitate towards anesthesiology.
“I love mental and technical challenges. That’s one of the reasons why I gravitated towards anesthesiology. Such practices have one of the most complicated billing and payment systems of any specialty. I’m up for and have been immensely enjoying this work for over 40 years,” says Joe Laden, who has served as Vice President of Client Management at AdvantEdge since April 1, 2017.
Joe’s primary goal is to make sure AdvantEdge exceeds client expectations. “There are often aspects outside of medical billing that we address for our anesthesiology practices, as well as for our other specialties. I understand that anesthesiology practices sometimes require support outside of the billing realm in terms of performance reports, financial concerns, along with issues related to hospitals, negotiations with payers and other relevant items.”
Let Providers Do What They Do Best
The many nuances of anesthesiology are no mystery to Joe. “Providers need to focus on their patients and leave their billing to us. Billing is of utmost interest to me – and it’s what I do best. It’s essential to give providers the space to take care of other aspects of their business outside of billing,” adds Joe, who is a regular keynote speaker at various conferences, including the Medical Group Management Association (MGMA), American Society of Anesthesiologists, and numerous state anesthesiology societies, along with other organizations.
Joe, who is a member of the Medical Group Management Association (MGMA) and Kentucky/Ohio Anesthesia Managers Association (KOAMA) recently shared his Data Analytics presentation at the ASA Advance 2022 Conference. Read more about AdvantEdge´s participation in this event and how to secure medical billing partnerships on our blog https://www.ahsrcm.com/blog/asa-advance-2022-tips-secure-medical-billing-partnerships/
On February 10th, the Centers for Disease Control and Prevention (CDC) issued an updated draft of its Clinical Practice Guideline for Prescribing Opioids. This draft provides revisions to the 2016 guideline, supported by new evidence and research in the field of pain management1. As the guideline is currently in draft, the CDC has opened the docket for public comment on its new recommendations.
Similar to the 2016 guidance, the guideline advises providers to limit the use of opioids when possible. If indicated, clinicians should consider alternative, non-opioid therapies for chronic and acute pain conditions. Such alternatives include other pharmacologic therapy (e.g., gabapentin or ibuprofen) and nonpharmacologic options (e.g., physical therapy). On the contrary, the CDC removed some of its previous recommendations that initially limited opioid use. The new guideline, for example, does not recommend limits on opioid dose and prescription durations as it did previously. It also advises against sudden discontinuation of opioids in certain patients with chronic pain.
Shortcomings of the 2016 guideline
Many of the changes seen in the updated guideline address the shortcomings from the CDC’s 2016 recommendations. One of the biggest changes includes the removal of opioid ceiling doses from the guideline. When the CDC defined these dose thresholds in 2016, certain states began to implement restrictions on opioid prescriptions to abide by these recommendations. For example, some states induced limits on the number of opioid doses or prescription refills a patient could receive. Additionally, many providers started to change their practice to avoid prescribing doses above the CDC-defined maximum. In fact, after the release of the 2016 guidelines, prescription of high-dose opioids declined at an increased rate. Additionally, the average day’s supply of opioid prescriptions decreased2.
These trends suggest how both law and clinical practice changed in response to CDC guidance in 2016. Decreased opioid utilization can be positive as it can also reduce the likelihood of opioid abuse and dependence. However, restricted prescribing can also lessen the quality of pain management for patients with uncontrolled pain. Likewise, the 2016 guideline created barriers to opioid access for many patients who required higher doses of opioids.
Impact of the 2022 guideline
The new draft guideline loosens some of the harsher recommendations from 2016, removing certain dose thresholds. Previously, patients that needed doses higher than the daily 90 morphine milligram equivalents were restricted, resulting in increased pain and decreased quality of life. By removing ceiling doses and allowing for more flexibility, the CDC encourages providers to leverage their clinical judgement when it comes to pain management. This process should involve careful evaluation of an opioid’s benefit-risk profile as well as patient-specific factors, allowing for comprehensive yet individualized treatment plans.
Outside of clinical practice, the 2022 draft guideline may also make an impact at an institutional level. As previous recommendations induced restrictions within prescribing laws and insurance reimbursement, the 2022 guideline may help to ease these restrictions. This would make opioids and pain relief more accessible to those that truly need it, creating balance and promoting compassionate patient care.
Last December, Congress finalized the Medicare physician billing rates for 2022, which overruled nearly 10% of proposed cuts that would directly impact physician pay. You can read more about the medicare fee schedule’s final legislation in our recent post, Final Medicare Physician Billing Rates for 2022.
However, Congress was unable to make a decision concerning the Clinical Laboratory Fee Schedule (CLFS), and postponed the proposed payment cuts to next year. Based on the legislation, the American Clinical Laboratory Association (ACLA) and 27 other health organizations sent a letter to Congress indicating how harmful these cuts would be to the health of millions of Americans, particularly those with chronic illnesses, senior citizens, and certain demographics.
Earlier this month, Congress renewed its call to address the Medicare fee schedule, which will directly impact radiologist reimbursement, as well as the potential to cut a large portion of core clinical services.
With these proposed cuts to reimbursement and professional services, the feds are looking to boost payments to benefit primary care and others who use clinical labor. However, this will come at a huge cost to professionals in the field, such as interventional radiologists and radiation oncologists.
Two representatives, Bobby Rush, D-Ill., and Gus Bilirakis, R-Fla., are leading the charge with 61 lawmakers to urge House and Senate leaders to address these changes and vote against the proposed pay cuts.
In a February 8 letter sent to both parties in the House and Senate, Rush, Bilirakis, and colleagues wrote:
“These ‘clinical labor’ cuts are the most significant negative impact of the 2022 Physician Fee Schedule by far and are expected to cut reimbursement by more than 20 percent for some specialties.”
Although claim denials are an inevitable reality in radiology (and in every specialty), there are steps you can take to minimize dreaded claim denials that eat up time, money, and energy. By having comprehensive and all-inclusive processes in place for claims submissions and adhering to the process, you have a system set to ensure that the documentation submitted meets all requirements. Doing so optimizes cash flow and minimizes billing costs.
So, put these three practices into play today!
Be Proactive: Having a process in place to secure prior authorizations (when required) is essential to ensuring that claims are promptly paid and don’t get stuck in the denial pile. Since imaging procedures like MRIs, CTs, and PET imaging come with higher price tags, taking a proactive approach to getting prior authorizations is critical. What’s more, ICD-10 diagnosis coding requires a high level of specificity when securing prior authorizations, so it’s wise to have a thorough process in place to make sure that prior authorizations are promptly handled – and handled correctly. You also want to make certain that the procedure performed is the same procedure noted in the paperwork. When it comes to prior authorizations, it pays to be proactive.
Is it a Match? A second tip to minimizing radiology claim denials is making sure the information submitted is accurate, complete, and up to date is essential to determine patient eligibility. Securing accurate data is a critical part of ensuring a smooth process. Something as simple as being off a single digit in an address can result in denials. Getting all the details and information – such as service location, insurance company, group number, subscriber number, coverage effective date, along with the patient’s address, phone number and birthdate – is crucial. This may sound obvious, however, it’s the root cause of many denials. Every bit of information that is noted must match what’s already on record. Failure to do so is likely to trigger a denial – and then the information must be promptly updated and corrected. Best to have a process in place to get it right the first time around!
Necessary Measures: Prior to scheduling procedures, make sure that you have shown the procedure to be a medical necessary. Unfortunately, there are often other factors outside of the physician’s recommendations to deem a procedure is warranted. What’s more, performing procedures to “rule out” specific conditions may result in denials if providers fail to submit relevant and detailed documentation to support the reason for the procedure – and this could vary by insurer,. Submitting the required documentation to show medical necessity is key to realizing positive outcomes from a reimbursement standpoint. Understanding what is required by each insurer and having a system in place that speaks to these requirements is crucial to making the case for a procedure to be deemed medically necessary.
Want to learn more about how your practice can limit its radiology claim denials in order to optimize cash flow? Get in touch with an AdvantEdge expert now, or stay up to date on company and industry trends by visiting our LinkedIn page.
AdvantEdge recently participated in the American Society of Anesthesiologists (ASA) Advance 2022: The Anesthesiology Business Event in Dallas, Texas where members of our team offered participants tips and insights about the nuances of medical billing.
In addition, Joe Laden, Vice President of Client Management at AdvantEdge, presented a lecture on Data Visualization that included an overview on how data is a driving force in optimizing provider practices. Here are three ASA Advance 2022 conference takeaways to help providers choose the best medical billing partner to meet their unique and specific needs:
1. Anytime, Anywhere Access: If your data is only attended to and reviewed every 30 days – a mere 12 times a year – you’re potentially missing out on 353 opportunities. Having anytime, anywhere access to your data 365 days a year allows you to drill down into locations, providers, whether you’re measuring up to contracts and rates – and much more – on an ongoing basis. Real-time data is a powerful tool to enhance processes and improve cash flow, so it’s essential to have quick, easy, and frequent access to this critical information.
2. The Whole Story: Being handed a stack of papers in a nifty binder won’t set the stage for success. You want a dedicated client manager – a medical billing partner who will interpret this data for you. How are you doing? What is happening? Where are you headed? What action can you and your team take? What story is being told through this data? Data is extremely valuable, but only if you thoroughly understand what the numbers represent – and act accordingly.
3. Comfort Level: When you’re giving your medical billing company access to millions of hard-earned dollars, having a high level of trust is crucial on many levels. You want a company that communicates with you on a regular basis and is readily available to offer input, updates and to answer any questions, so you’re never left in the dark. You want to understand the thinking behind their strategy.
Look for a company that offers value-added services like supporting you in securing new business; increasing revenue; advising on special cases, and that offers you input when confronted with inconsistencies in your business model. When you require guidance, it’s essential to know you can reach out to first-rate specialists who deliver and exceed your expectations.
Get the Edge
At AdvantEdge our highly trained and experienced staff understands how precious time is for providers and recognizes that every practice has unique and specific needs in the way of medical billing. Our hands-on ClientFirst billing approach supported by our highly reliable, secure, and proprietary technology optimizes billing workflows to meet the specific needs of every one of our valued clients.