Running a successful medical practice involves solving many puzzles; one of the hardest is how to successfully deal with patients who don’t pay their bills. Many medical practices turn to collection agencies for help. Although, too many health care providers insist the percentage agencies don’t live up to their expectations:
For many medical providers the age old question is, "should our practice be in or out of network?" The answer depends on your location and specialty. By this we find general primary care providers in large metro areas choose to be in network because limited payers, such as BCBS, Medicare and Medicaid and in competition for the same patients. Where patients are less restricted many medical practices find being out of network has advantages such as higher reimbursements for the same in network contracts. Probably the two highest drawbacks are the following:
If your practice accepts Medicare every provider must report at least one quality measure on one Medicare Part B patient (Not Medicare Advantage) on a 2013 date of service to avoid the 1.5% pay cut in 2015. Please see list of measures:
For the most part, supplies and materials are typically bundled with the service/procedure and are not payable separately. According to the AMA CPT guidelines, there are specific codes used to bill for supplies and materials.
According to published statistics and my experience auditing medical records, physicians mainly use code 99213 for established office visits and rarely, if not at all, use code 99214. I have seen many cases where the medical record warrants the higher level, however physicians automatically or routinely select the lower level code without any consideration for the higher one. This practice of under coding possess a potential loss of revenue and physicians may be shortchanging themselves.
It is in a billing company’s best interest to always stay on top of revenue leaks and maximize profits. A billing company is another set of eyes that recognizes operational failures that can cost a practice big money. The main objective of a billing service is to improve efficiency, reduce costs and increase reimbursements while leveraging state-of-the-art information systems. Management teams have a diverse background in practice management experience, coding expertise, operations management, information systems, insurance claim processing as well as state compliance and federal HIPAA guidelines.
If so, here are a few tips that may help you get paid for the services you provide to your patients.
One of the most efficient ways to expedite timely reimbursement is to conduct proper verification and pre-certification of services. So often, surgery centers are short staffed and reluctant to spend time on the phone verifying coverage. The following steps will result in prompt payment along with clean claims to the insurance carriers.
There are many reasons physicians feel stressed with today’s current state of medicine. With external factors such as the regulatory environment, declining reimbursement, increased malpractice liability and an educated (and somewhat demanding) patient population, it’s no wonder physicians feel a lack of control over the future of their practice.
All specialties grow at a different pace. When planning your practice it helps to understand the volume of procedure along with your physician’s schedule. One way to assess your volume is a procedure analysis and your schedule. This will help determine if you are maximizing your income by specialty, if you have appointments out more than three months you may need to hire another physician or adjust your hours of operation.
Physicians are you aware of your options when you are required to miss work due to illness, pregnancy, continuing education, or even vacation?
If you wish to take a short leave or an extended absence there are options available to you.
CMS established Local Coverage Determination (LCD) in section 522 of the Benefits Improvement and Protection Act of 2000 (BIPA 2000). In this policy change, all Local Medical Review Policies (LMRP) were converted to LCDs. The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) of the Act. Whereas LMRPs may have also contained other information such as coding and payment guidelines.