The changes incorporated in the healthcare industry in processes like medical billing, due to the Affordable Care Act (AFA) may not be as affordable for the US physicians as for the citizens. It is advisable to have a proactive approach to safeguard your medical practice’s revenue. The healthcare reforms and introduction of new systems like the Meaningful Use (MU) Stage 2, ICD-10, patient quality report system (PQRS), payment incentives, etc. are reported to cause revenue loss in many industry reports.
How does Proactive Medical Billing Help?
The best way of dealing with a supposed crisis is to be prepared and take preventive actions or focus more on the areas that are likely to hit. In this case it is your revenue that’s going to take the direct hit.
The administrative tasks like documenting and filing the claims accurately with the new coding system too will be all the more time taking so, you as a medical practitioner should follow the below mentioned steps to stay afloat on the choppy waters of healthcare reforms.
- Track those Pending AR
The healthcare industry reports that most medical practices leave their money on the table in fear of the time taking follow up and rework process. They also want to avoid losing out on the subsequent claims that are in line. The pending account receivable (AR) figures from the last quarter or the quarters of the previous year is the best indicator of how efficient your revenue cycle management (RCM) has performed. Use the report to analyze your strategy and rework on it touching the wanting areas.
- Verification and Credentialing
Many medical practices face revenue delays from the patient’s end. One of the solutions for this issue is to have a thorough verification process before the patient arrives for the appointment with the physician. This way the front end staff can verify the coverage of the patient’s policy, whether the patient has paid the deductible, etc. This will also be helpful in knowing your patient’s insurance policy and coverage status, economic background or paying capability better. You can then carve out ways to ensure quicker payments.
- Deductibles and PQRS
The beginning of a new year is usually the period when citizens are supposed to renew their health insurance policies but statistics say that more often than not they fail to do that. Given the increasing number of citizens covered under Medicare and Medicaid, it is more important than ever to check if the patient has paid the deductible to avoid delays in getting reimbursed.
The Centers for Medicare and Medicaid CMS) have introduced incentives for the physician quality reporting system (PQRS) in 2014 and focused more on the quality of service. This leaves no option for the physician except for the prolonged wait for the reimbursement after the insurance company processes the claims and the patient sees the explanation of benefits (EOB).
- Patient Influx with Low Returns
Usually patient influx is a good news for medical practices in terms of business but with the revision of reimbursements of the patient fee schedule (PFS) and transitioning from fee-for-service / pay for performance (P4P) to value based reimbursement (VBP), physicians are expected to get low returns as compared to their services.
- Coding Errors and EHRs
The MU endorses using electronic health records (EHR) for better accessibility, care coordination, improving patient care, patient participation and as a cost saving measure too. Avoid the common billing mistakes like upcoding, downcoding, using modifiers incoorectly, etc. and save your revenue from dipping.