Denials management and appeals are the two most underestimated processes in rheumatology offices. Most practices lose thousands of dollars every year because they are not following up or writing off denied claims correctly.
To Document or to Doctor? That Is the Question
Is paper pushing taking away from patient care?
Avoid Compliance Risks When Using Billing Companies
Outsourcing your billing to a third party will not alleviate your compliance duties or reduce your risk of a government investigation. Conversely, a relationship with a third-party biller can increase your compliance obligations and raise audit risks.
A New Twist in the Consumerization of Healthcare
Who are the new medical consumers? These people behave like medical “shoppers” because they are more mobile than previous generations and are empowered by the Internet. They can research and form opinions about diseases, treatment options, and the best route to recovery—all before stepping foot in to an exam room. This emerging population has been taught that in order to be a health-wise consumer and to get the most value, a patient must take an active role in his or her care.
How Medically Unlikely Edits Affect a Practice
Medically unlikely edits (MUEs), formally known as medically unbelievable edits, took effect with the Centers for Medicare & Medicaid Services (CMS) on January 2, 2007. The function of MUEs is to detect and deny unlikely CMS claims on a pre-payment basis with the intention of improving Medicare’s payment process.
Mind Your Accounts Receivable
Over time, one would expect financial management of a medical practice to become more streamlined and simple. With the abundance of electronic tools, software programs, and the Internet, you can find assistance and problem-solving strategies for economic efficiency. In the rush to take advantage of these support tools, basic facets of financial management, such as billing and collection, have fallen by the wayside.
Missed Appointments Equal Missed Revenue
What do you do when a patient misses an appointment? While an opening in the schedule might seem like a good time for staff to take a break or catch up on their to-do lists, missed appointments are a growing problem in physician practices. With today’s need to maximize every dollar, practices should take a closer look at the effect these missed appointments have on their bottom lines.
Clean Claims Equal Prompt Payment
Submitting a clean Medicare reimbursement claim the first time can save your practice thousands of dollars each year. The Centers for Medicare and Medicaid Services (CMS) defines a clean claim as “a submitted patient claim form without any defect or need for substantiation.”
Is Your Office Lab Up to Par?
Rheumatology practices with laboratory testing facilities in their offices can offer important benefits to patients and physicians. During their care of patients with musculoskeletal and rheumatic diseases, rheumatologists may order many tests, including erythrocyte sedimentation rate, synovial fluid analysis, complete blood count, fecal occult test, and urinalysis. While the prompt receipt of test results and the capability to evaluate specimens in the office directly improves efficiency, it is important to remember that offices must be certified to perform laboratory testing, particularly high-complexity tests such as the analysis of synovial fluids.
Fraud and Abuse: What’s the Difference?
Each year, fraud and abuse cost the Medicare and Medicaid programs billions of dollars. What is the difference between fraud and abuse? The Centers for Medicare & Medicaid Services define fraud and abuse as two different offenses…
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