The Centers for Medicare & Medicaid Services just announced changes to the performance category of the Merit-based Incentive Payment System (MIPS): from 15% to 0% weighting for the 2020 performance period – which affects 2022 payments. CMS cites the impact of the COVID-19 public health emergency as the reason for the change. It will redistribute the 15% to another performance category or categories. Read more
CMS | 1 min read
Medical Groups Urge CMS to Walk Back ACO Quality Overhaul, Citing Potential Negative Impact on Patient Care
Medical groups want to delay or make significant changes to the way accountable care organizations report and are measured on quality. Read More
HIPAA | 2 min read
Providers Supportive of Push to Overhaul HIPAA but Air Serious Concerns About Data Privacy, Timing
Provider groups are worried that too much information sharing of patients’ medical history could impact privacy and inequities in care. Read More
Radiology |2 min read
Hospital-based Primary Care Doctors Order More Inappropriate MRI Scans
According to a recent study, more inappropriate MRI scans are ordered by hospital-based physicians than those in private practice. Read More
CMS | 1 min read
Many Changes as Surgeries Move to ASCs
CMS added hundreds of surgeries and procedure codes to the ASC payable list in 2021 and revealed plans to eliminate the inpatient-only list over the next few years. ASC and hospital administrators are paying close attention to how CMS rolls out new ASC approvals and whether commercial payers update their policies to follow suit. Read More
Practice Review Kit
Compare your performance to other practices and benchmarks.
Medical coding is like racecar driving… if you stay idle, you lose. The coding landscape is forever evolving with new twists and turns every step of the way, and providers have no time to waste when it comes to staying on track. AdvantEdge welcomes you to our three-part series on the complex world of medical coding with an emphasis on what you need to know before committing to a medical billing or medical coding company. Below is an overview of what each upcoming blog will address. We invite you to share your feedback and comments – and we hope this information will be instrumental as you ensure that your medical billing company is appropriately maximizing reimbursement for all your hard work. If you do your homework and use a medical billing company with superior coding capabilities, you will experience a smooth road ahead!
(Part 1) Coding Counts: Medical Coding in an Ever-Evolving Landscape
The world of medical coding is forever evolving. With new Medicare regulations involving Medical Decision Making (MDM) implemented earlier this year; coding changes due to COVID and telehealth; and now exit strategies needed when COVID coding provisions potentially revert to pre-COVID status, using a company that employs certified coders and embraces leading-edge technology is critical. Healthcare providers must also make sure they choose a medical billing company that thoroughly understands and stays current with all aspects of coding in their specific area of specialty – and does so in a timely manner. Our upcoming blog post will offer a comprehensive overview of the importance of understanding these factors – and will highlight key questions to ask before deciding to partner with a company.
(Part 2) Turning to Tech: Keeping up with Technology & Automated Workflows
With an increasing and evolving abundance of data associated with revenue cycle management and specifically coding, technology and workflow processes are essential considerations when choosing a medical billing company. Today’s medical billing companies must implement and utilize the latest technologies, as well as maintain the ability to customize workflows – and steer clear of cookie-cutter approaches. Leading providers want to partner with a company that considers technology a top priority and relies on proprietary software specifically designed for physician billing. These technologies are essential when dealing with coding and its abundance of workflows. Our upcoming blog post will offer a comprehensive picture of the importance of technology in the coding and workflow processes – and will highlight key questions to ask before choosing or assessing a medical billing company.
(Part 3) Partners in Profitability: Education and Compliance
Education and compliance go hand in hand and are essential to both coders and healthcare providers. Like the saying goes: “Knowledge is power,” and this is especially relevant in the complex world of coding. No one wants to see their hard-earned dollars left on the table, and that includes healthcare providers. Our clients help their patients optimize their health, and it is our job to ensure they are appropriately paid for those services. Team up with a medical billing company that excels in these areas – and that thoroughly understands the nuances of the forever-evolving coding landscape (and shares this knowledge with their clients through education and training.) A best-in-class medical billing company collaborates with its clients on issues around proper clinical documentation; promptly conveys changes in regulatory requirements and compliance; informs providers of coding changes and how they impact provider documentation; and serves as an ongoing source of education and information. Our upcoming blog post will offer a healthy overview of the importance of education and compliance – and will highlight key questions to ask before selecting a medical billing company.
We look forward to diving into this in-depth series about coding, where we share critical thoughts and ideas about this important component of the revenue cycle management journey. Stay tuned for Part One of our Three-Part Series where we share essential questions to ask a medical billing company about its coding capabilities. Answers to these questions could very well impact your bottom line. Until then, keep up to date on AdvantEdge and its medical billing initiatives by visiting our LinkedIn page.
BILLING PERFORMANCE THAT MATTERS
“Treating” Your Patients with Care
With high deductible plans proliferating, more and more consumers have to pay a large portion of their medical bills. Many of them find it increasingly difficult to meet their financial obligations. We describe how AdvantEdge works with patients so that they can resolve their bills with dignity and respect, enabling a consistent cash flow for providers. Read more
CMS | 1 min read
ACA Sign-ups Reach 500K / Fewer Uninsured
More than 500K Americans have signed up for the ACA, reducing the number of uninsured citizens. Read More
COVID-19 | 2 min read
Covid-19 Causes Sharp Decline in Cancer Screening
Deficits in breast and colorectal cancer screening exceed 25%; prostate cancer screening deficit exceeds 10%. Read More
Radiology | 1 min read
Radiology Groups Confidence Continues to Improve
Radiology professionals optimistic that operations will maintain or grow in the wake of COVID-19. Read More
CMS | 1 min read
Information Blocking Rules Now in Effect
Effective April 5, new rules require finalized electronic reports to be released to patients. Read More
Practice Review Kit
Compare your performance to other practices and benchmarks.
A recent AdvantEdge report, “Evaluating the Pandemic Impact on Medical Billing,” focuses on how COVID-19 changed certain dynamics in the healthcare industry, a primary example being the impact on payer mix. Unlike healthcare plans of the past, which gave freedom to consumers to proactively address their healthcare needs without some of the significant financial burdens presented today, current health insurance offerings are forcing more consumers to accept plans with high deductibles and high copays, all while paying high premiums.
In short, the significant economic impact placed on patients to receive the care they need has continued to increase, regardless of the various insurance choices available. More and more, patients think twice about whether that sore shoulder or back pain requires medical attention – or if it can be self-managed.
How AdvantEdge Helps Patients Address this Economic Challenge
When dealing with a medical bill, it is understandable that patients may feel angry, overwhelmed, or upset; they did not choose to get sick or injured, may not have had a choice of provider, and probably didn’t know how much treatment would cost before the visit (or even after the visit but prior to getting a bill). AdvantEdge recognizes these conditions and that paying medical bills is a highly personal and sensitive matter. As a result, AdvantEdge takes a number of measures to ensure that they empathize with the patients’ situations and work towards resolving their bills respectfully. The statement below is from our recent report, which quotes David Langsam, President & CEO, of AdvantEdge Healthcare Solutions:
“The medical billing industry will need to treat patients with compassion, empathy, and a solution-based approach that enables them to meet their financial responsibility with dignity and respect…Since the patient is already under a degree of stress, we must strive to make them feel empowered and appreciated and deliver a positive experience regardless of the pressures of the moment. When evaluating current billing and practice operations to ensure the patient experience achieves these objectives, it’s important to take an in-depth look at your existing processes, vendors, and partnerships.”
Empathetic Representatives: AdvantEdge spends considerable time and effort finding the right representatives to interact with patients. Our specialists understand that every patient is unique – and so is his or her situation. Instead of starting the conversation by highlighting what the patient may “owe”, first seek to understand their perspective of the situation and walk them through the economics of what was and wasn’t covered by their insurer, and why. Seek first to understand, then to be understood. Once our specialist and patient are aligned on the circumstances and status, only then should we be asking the patient how they would like to resolve the outstanding amounts due. In other words, unless you are aligned on the problem, you cannot expect to agree on a solution. Based on the patients’ situations, reminding them that they can use a credit card, or establish a payment plan may also be a great way to be viewed as supportive and on their side. And remember, a healthcare bill is usually both unexpected and undesirable, so care…and as our COO always says, have a smile in your voice.
Billing Visibility: Unlike going into a store where prices are clearly marked, healthcare is unique in that when visiting your provider for treatment or an appointment, there is usually no simple way of knowing the true costs involved in your care. Oftentimes, patients receive bills, have sticker shock, and become frustrated because – even with the bill in hand – they don’t understand the cost breakdown. AdvantEdge provides visibility into every bill and walks patients through how everything adds up. Visibility and clarity into their financial responsibility goes a long way in helping patients understand and move towards resolving the issue as opposed to rejecting the issue.
Methods of Payment: Due to its sensitive and private nature, patients like to review and meet their billing responsibilities on their own terms, at their own convenience and through their preferred platforms. AdvantEdge enables billing review and payment options via email, web portal, and even “agentless” telephone inquiry and resolution, as well as implementing text messaging where permissible. Through all of these options, patients are still able to have a live AdvantEdge rep engage if a patient requests such in order to address more complicated questions or collaborate on alternatives.
In part 2, we’ll discuss how AdvantEdge technology plays a critical role in the revenue cycle management process, to ensure that clients receive the payments they are rightfully due for the services they deliver. To stay up-to-date on AdvantEdge and medical billing news, visit our LinkedIn page for more.
Deep Understanding of Healthcare & Expertise in Proven Technology
WARREN, NJ – April 12, 2021: AdvantEdge Healthcare Solutions (“AdvantEdge”), one of the top ten medical billing, coding, and practice management companies in the U.S., today announced a milestone in the company’s history by celebrating the 20-year anniversary of Jeanne Gilreath, OHCC, CHBME, who is a Cofounder and Chief Compliance Officer at AdvantEdge.
One of three company founders, Gilreath witnessed AdvantEdge’s transition from its origins as a small company launched in 1999 to a global organization now boasting over 800 employees.
Gilreath was confident the company would realize a prosperous future: “I knew from the start that we had a winning combination for success given our deep understanding of healthcare coupled with our expertise in developing and deploying technology to drive results on behalf of the provider community. Our team had the expertise to keep on top of ever-evolving changes in revenue cycle management and the market as a whole. When we took on a financial partner in 2006 to secure additional funding and brought on a seasoned CEO in 2007, the business really took off on a national level,” said Gilreath.
With over four decades of solid healthcare experience, Gilreath has been an active member of the Healthcare Business Management Association (HBMA) since 2002. Among other positions, she was elected to two 3-year terms on the board and served as HBMA’s 2014 president. HBMA is the only 501c3 national trade association of revenue cycle management companies. Gilreath also holds memberships in AIHC, HCCA, MGMA, AAPC, and RBMA. Earlier in her career, Gilreath served as Regional Vice President of the Practice Management Group at McKessonHBOC, as well as Regional Vice President at CyCare Systems, Inc.
Gilreath highlights how AdvantEdge’s client-first philosophy facilitates positive outcomes. “We know the challenges facing each of our clients. Before telling potential clients what we want them to know about our business, we make sure we learn everything about their business and their concerns. Meeting the unique needs of each of our clients is what allows us to continue to grow and deliver optimal service,” said Gilreath.
John P. McGahan, President/CEO of the Gavin Foundation, a comprehensive substance abuse agency, shares his experience partnering with AdvantEdge: “Our decision to partner with AdvantEdge has resulted in several improvements for our organization. With the help of AdvantEdge’s seasoned staff, we have been able to effectively manage the expansion of our operations. Having open access to our data and information has provided us with greater confidence in predicting our current and future revenue stream. Outsourcing our billing with AdvantEdge has helped us become more efficient and allows us more time to spend on patient care and executing our growth strategies.”
About AdvantEdge Healthcare Solutions
AdvantEdge – an industry innovator giving medical professionals the freedom to focus on delivering exceptional healthcare – is recognized as one of the top ten U.S. billing, certified coding, and practice management organizations. With powerful, individually tailored, outcome-based financial-management solutions, AdvantEdge collects more than $1 billion annually for physicians, hospitals, ambulatory surgery centers, behavioral health agencies and large office-based medical groups. Client-first service, robust technology, and actionable business intelligence and reporting translate into healthier clinical practices. To learn more about AdvantEdge, visit our website at www.ahsrcm.com. Follow us on Twitter at @DoctorBilling and on LinkedIn.
Ryan Siss, Fastlane on behalf of AdvantEdge [email protected]
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