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Why it’s Best to Outsource Your RCM

Revenue cycle management (RCM) is one of the most important parts of your clinical practice. It’s also one of the most challenging, especially for small practices with a limited number of staff who are asked to take on a lot during a typical day. Keeping your practice profitable means collecting as much of your billed charges as possible, so for many small and independent practices a better option is to outsource revenue cycle management (RCM) to a third-party vendor. Here are just a few reasons it might make sense for your practice.

1: Manage Growth

As a small practice you may have been able to manage billing on your own, even with limited staff, when your practice was small. As you grow to add new providers, new services, new clinic locations, or more patient volume, that billing can get more complicated. Third-party RCM vendors have expertise in medical billing services for a wide variety of medical specialties and clinic sizes. They also have a dedicated staff of medical billing professionals that they can expand as you grow. You won’t need to hire more staff or provide more training as your needs change.

2: Control Costs

The largest expense for almost any organization—medical practices included—is staffing costs. Hiring a staff member means paying a salary, taxes, benefits, and other costs, and those can add up quickly. If you are struggling with clinic profitability, one of the best ways to cut operational costs is to reduce your staff. Most clinics don’t want to do that on the medical staff side because you want to maintain a high level of service for your patients. Outsourcing your RCM makes a lot of sense to keep staff costs low.

3: Maximize Collections

Healthcare payment models are very unique; you provide a service today, but often don’t get paid for an average of 40-50 days after the service is rendered and you may get paid from multiple sources (one or more payers and patients). The more time that goes by between date of service and payment, the less likely you are to collect the full amount. Practices that have small or inexperienced RCM staff may not be able to focus enough attention on collection efforts to maximize it. If you notice are collecting less than 80% of your billed charges, outsourcing can not only cut costs, it could also improve collections so the overall benefit to your bottom line is significant.

4: Streamline Billing

Medical billing can be complicated, and even small errors can result in denied insurance claims, which shifts the burden of payment to your patients and is frustrating for everyone. An experienced RCM outsourcing company with a good track record for submitting clean claims and getting paid immediately, that also knows how to follow up on denied claims properly, can streamline your services.

Onpoint Medical Solutions is a trusted partner of AdvancedMD, with solutions that integrate medical billing into your EHR for increased productivity and savings. Find out more today.

How to Save Money on Prescription Drugs with GoodRX and RXSaver

Did you know that different pharmacies charge different amounts for the same medication?  What if there was a way to not only find the best price for prescriptions and medications but also get a discount?

It doesn’t matter if you are taking one medication or several, everyone wants to know what the out-of-pocket expense is going to be.  Whether you have insurance or not every dollar counts in medical expenses and the cost of medicine can add up quickly.  And don’t assume because you have insurance that you’re getting the best price for your prescription drugs.

Today, I am sharing two tools that can not only save you money but allows you to compare prices at nearby pharmacies to ensure you are getting the best price.  I have no vested interest in either of these tools.  They are both free; they work, and I just wanted to share.

The first tool is called RXSaver by RetailMeNot.  RXSaver works by giving you access to prescription pricing information.  It can save you up to 80% on your prescriptions, whether you have insurance or not.  RXSaver is an online tool that can help anyone save on prescription medications.  And for those of you who rely on your phone to help manage your life there is even an RXSaver app.  You will want to check out RXSaver for more details.

The second tool is called GoodRX.  GoodRx reports that the country spends more than $500 billion on prescription drugs each year.  Americans pay on average more than $1,200 for their medications per year, which is far higher than in any other developed nation.

They are similar to RXSaver in that they compare prescription prices; show the lowest price and provide discount coupons.  They have both an online presence and a mobile app

GoodRx offers competitive pricing by looking across the various retailers, including Walmart, Costco and CVS.  That price is often cheaper for the consumer than the cash price offered at the register, which is typically highly inflated. 

Check out both RXSaver and GoodRX.  Download the apps and use whichever one offers the best price.

Medical Billing Receptionist

ROLE SUMMARY:
The Medical Billing Receptionist is responsible for a variety of billing functions that support all departments and performs a variety of duties under general supervision.

ESSENTIAL DUTIES:

  1. Primarily responsible for supporting the Posting and Claim Center departments to include but not limited to.
    1. Posting the payment and non-payment remittances of all patient and insurance transactions both electronic and paper, as instructed.
    2. Research of items in efforts to post with 100% accuracy may require extensive online and phone communications.
  2. Responsible for other department support as needed which may include but not limited to sorting mail, calling on patient balances, assisting credentialing and following up on paperwork, filing, indexing and working collections correspondence. All will require a high level of documentation recorded within our online systems.
  3. Answer phones and resolve calls accordingly. This will include, but not necessarily limited to, negotiating payment plans with patients, accepting payments over the phone, updating patient demographics, rebilling insurance and sending tasks to others for further review and follow-up.
  4. Complete all tasks received via the Onpoint dashboard, daily.
  5. Abide with HIPAA and PHI guidelines at all times.

SKILLS, KNOWLEDGE, AND ABILITIES:

      1. Excellent verbal, written and interpersonal communication skills.
      2. Proficient with Windows, MS Office, Outlook and Internet Explore
      3. Computer and keyboard skills are a must.
      4. Excellent organization skills and attention to detail
      5. Demonstrates an independent work initiative, sound judgment and strong work ethic.
      6. Ability to handle multiple tasks simultaneously
      7. Experience with AMD practice management software a plus but not required.

MINIMUM REQUIREMENTS:

    1. High school diploma or GED
    2. Two year of experience in a health care setting, preferably with accounts receivables.

The above statements are intended to describe the general nature and level of work performed by people assigned to this job.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel and employees may be required to perform other duties as assigned.

MGMA COVID-19 Medical Practice Reopening Checklist

Do you know what it will take to open your medical practice?  Recently, the Medical Group Management Association (MGMA) provided a COVID-19 MEDICAL PRACTICE REOPENING CHECKLIST that is a great tool to help you navigate this next phase.  Many providers may think that as soon as you announce the re-opening that the patients will come but that may not be true.  So, it is best to plan ahead.  This is a great resource to help you determine your reopening readiness. 

The MGMA has been a leading association for medical practices, administrators and executives since 1926.  They are a national organization representing more than 40,000 medical practices of all sizes, types, structures and specialties.

There is a Cure to Medical Necessity Denials

Did you know that claims for services that do not meet the requirements of medical necessity are getting denied instantly? Payers are increasingly more focused on the issue of medical necessity.

Medical necessity is difficult to define, since there are so many interpretations and they vary from payer to payer. Most typically incorporate the idea that healthcare services must be “reasonable and necessary” or “appropriate” based on the patient’s condition and current standards of care.

DENIALS, RECOUPMENTS, PENALTIES

Sadly, the decision as to whether services are medically necessary are made by someone who has never seen the patient. Most payers use automation to review and deny claims. These are called claim edits. The edits ensure that payment is made based on a specific diagnosis related to specific procedure codes. Diagnosis codes identify the medical necessity of services provided.

CMS has the power, under the Social Security Act, to determine whether each situation is reasonable and necessary. Even if it is that they later determine do not meet medical necessity the scope of the service can be limited.

To make matters worse, if a carrier pays for services that they later determine to no meet medical necessity, they will recoup those payments. They can demand a refund or just deduct the amount directly from a future reimbursement check. They also have the right to charge interest.

If they determine that the provider has a pattern of billing for medically unnecessary services, the provider may face monetary penalties, exclusion from the Medicare program, and criminal prosecution.

HOW TO AVOID MEDICAL NECESSITY DENIALS

According to the American Academy of Professional Coders (AAPC), there are 8 key steps to follow:

  1. List the principal diagnosis, condition, problem, or other reason for the medical service or procedure.
  2. Assign the code to the highest level of specificity.
  3. For office and/or outpatient services, never use a “rule-out” statement (a suspected but not confirmed diagnosis); a clerical error could permanently tag a patient with a condition that does not exist. Code symptoms, if no definitive diagnosis is yet determined, instead of using rule-out statements.
  4. Be specific in describing the patient’s condition, illness, or disease.
  5. Distinguish between acute and chronic conditions, when appropriate.
  6. Identify the acute condition of an emergency situation; e.g., coma, loss of consciousness, or hemorrhage.
  7. Identify chronic complaints, or secondary diagnoses, only when treatment is provided or when they impact the overall management of the patient’s care.
  8. Identify how injuries occur.

If your claim is still denied your billing company should appeal the denial. This will require additional work on their part. It takes a lot of work and time to appeal a denied claim. It is tedious work and billers don’t like doing it. It is hard-earned money and one of the many ways a good billing service earns its money. It also requires that the medical note supports the coding. If the appeal is handled correctly there is a good chance the denial will be reversed, and the claim will be paid.

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