The pMD Blog

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pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.


Here's The Latest in Health Care:


The COVID-19 pandemic has redefined how health care is delivered as well as how people pay for it. On the delivery side, patients and doctors offices have embraced telehealth appointments; on the financial side, patients have turned to contactless payment modalities and phone apps to handle their balances. Digitalization can simplify the medical bill payment process and give patients more information, earlier on, about their financial responsibilities, experts say.  Read More

Care coordination and patient outreach is a proactive approach to care management that can drive positive outcomes such as reduced emergency department visits, decreased hospitalizations, and fewer hospital readmissions. A Tennessee-based physician group is successfully utilizing analytics to target patients who have been discharged from hospitals to fill gaps in care and manage transitions of care.  Read More

Ransomware attacks skyrocketed amid the pandemic when hospitals increased their use of remote work and moved more hospital data online. According to a new report, 560 healthcare organizations were victims of ransomware attacks in 2020, costing healthcare organizations $20.8 billion in downtime, double the amount it cost in 2019.   Read More

Large tech giants are jumping into a growing interoperability solutions market as new federal regulations spur the healthcare industry to open up and share medical records data. Google Cloud rolled out a new tool called the healthcare data engine, currently in private preview, that helps healthcare and life sciences organizations harmonize data from multiple sources, including medical records, claims, clinical trials and research data.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.

Here's The Latest in Health Care:


If finalized, the Quality Payment Program (QPP) will undergo significant policy changes under the Medicare Physician Fee Schedule (PFS) proposed rule. Most notably, the rule introduced the first seven Merit-Based Incentive Payment System (MIPS) value pathways, which will be used to streamline MIPS reporting requirements in the future.  Read More

Healthcare workers already had a high rate of stress and burnout, but the COVID-19 pandemic has greatly exacerbated the problem. In response, HHS is using $103 million from the pandemic relief fund in an attempt to help reduce burnout and provide mental health services to U.S. healthcare workers.  Read More

According to a new study, nearly 90 percent of physicians reported that data interoperability should be a priority at their healthcare organization right now. With enhanced interoperability and streamlined patient data exchange, providers can bolster patient-centered care delivery for improved outcomes.  Read More

Less than a year after CMS finalized the three-year phaseout of the inpatient-only (IPO) list to be completed by 2024, the agency is looking to reverse course, according to the 2022 OPPS proposed rule. In addition, CMS says it intends to increase hospital compliance with its price transparency policies by increasing financial penalties for certain facilities.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.

Here's The Latest in Health Care:


The top revenue cycle key performance indicators (KPIs) are evolving as more organizations use automation to pinpoint high-value operations to improve revenue cycle management. Leaders have identified the number of days a claim sits in accounts receivable, the number of past due patient bills, and initial denials rates as top revenue cycle KPIs.  Read More

CMS released its annual proposed changes to the Physician Fee Schedule for 2022, which expands certain Medicare telehealth provisions, updates the payment rate for physician services, implements changes to the Quality Payment Program, among other updates.  Read More

The COVID-19 pandemic pushed people to embrace new avenues of care, and take greater control of their own health, according to a new study from CVS Health. Of those surveyed, more than 75% of people said the pandemic led them to pay more attention to their health overall, while 50% said they felt the stay-at-home orders under the pandemic helped them achieve their health goals.  Read More

After a spike at the onset of the coronavirus pandemic, telehealth use has stabilized at levels 38 times higher than before the pandemic. This strong continued uptake, along with favorable patient responses, and new investments in the technology will propel the growth of telehealth in 2021, according to a report. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.
Ensuring a clean claim to avoid denial


If you were to Google, “What is RCM?” you’re not going to find an easy answer. At its most basic level, Revenue Cycle Management is defined as the financial process that health care practices and providers use to track patient care episodes. However, the search will spit out a myriad of definitions, and a laundry list of vendors, advertisements for new medical billing software, and companies promising to help improve your revenue cycle. Let us break it down for you. 

When does the revenue cycle begin?


Many vendors may say the revenue cycle begins when a provider renders a service to a patient. At pMD, we think of it a little bit differently. We believe the revenue cycle begins long before the patient even steps foot in the office or onto a video call. A successful revenue cycle starts at the point of patient registration and appointment scheduling. Making sure a patient is set up, ready to go, has paid their co-pay, and insurance has been verified prior to their appointment is crucial to ensuring the patient has a successful visit, and the provider is reimbursed in a timely fashion. In fact, one of the most common reasons for claim denials is due to “missing information,” such as the patient’s insurance or demographic information is not accurate, up to date, or incomplete. Finding a solution that helps you gather and verify correct patient information upfront, prior to an appointment, pays huge dividends in a practice’s eventual collections and overhead costs.

When does the revenue cycle end?


Some may argue that the revenue cycle ends when reimbursement from a patient and/or payer hits your bank account. Others might say that the revenue cycle never really ends, since the lifecycle of a patient relationship can be long and complex, with one episode of care bleeding into the next. Here at pMD, we believe that it’s all about consistently finding ways to simplify and shorten this cycle. Additionally, carrier relationships can be complex and iterative, meaning there is always room for improvement. One piece is clear though - the ultimate goal of an RCM partnership is to reduce the amount of time it takes for a practice or provider to get reimbursed for services, while also maximizing those reimbursements. As the saying goes, your dollar today is worth more than your dollar tomorrow. 

How do you measure the health of your revenue cycle? 


There are various metrics used to measure the efficiency of one’s revenue cycle, and the importance of each is going to depend on the individual practice and their unique priorities. The most commonly used measurement technique is known as days in AR, or accounts receivable. Days in AR is a measurement of the average time it takes to collect payments owed to the practice. Days in AR gives you a snapshot idea of how quickly you are getting reimbursed for your services, and by extension, how effective your revenue cycle is. Another common way to measure one’s revenue cycle is through overall collections, which can be drilled down further, to examine collection trends by payer or even by charge code. The appropriate metric used may depend on an individual organization’s specific needs or goals. 

What can I do to improve my revenue cycle?


Ask an expert! Here at pMD, our mission is to streamline and optimize as many areas of the patient care episode and the revenue cycle as possible. Through our integrated RCM software and services, we’re able to help practices consolidate vendors, reduce costs, streamline workflows, improve patient care and satisfaction, and collect your maximum reimbursement quicker. Not sure what a vendor could do to improve your financial metrics? Contact pMD for a no-commitment financial impact analysis by our team of RCM experts FREE of charge! 

If you are interested in learning more about pMD’s Billing & Revenue Cycle Management Services, please contact us here or give us a call at 800-587-4989 x2. 

 

Related Articles:

What are Comparative Billing Reports? 
Reduce Claim Denials with Real-Time Eligibility 
Is your revenue cycle vendor a true strategic partner?


To find out more about pMD's suite of products, which includes our charge capture and MIPS registrybilling servicestelehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:


Revenue cycle management optimization is a top priority for financial leaders coming out of the COVID-19 pandemic. Both volumes and revenues are trending towards pre-pandemic levels, which has put pressure on health care organizations to revamp their processes to ensure a smooth revenue cycle in the future. Here are three strategies provider organizations have executed in the past year for revenue cycle management optimization.  Read More

A major rule that bans surprise medical bills has also outlawed policies that let insurers retroactively deny emergency department claims. CMS has released an interim final rule that prohibits balance billing and includes several provisions requiring providers to notify patients of new consumer protections. But tucked into the 411-page regulation, the first in a series, is a provision that targets a controversial practice where insurers deny an ED claim if the diagnosis isn’t considered an emergency.  Read More

A new study led by the Cleveland Clinic found that patient satisfaction with their virtual engagements with clinicians is comparable to in-person care. The average overall satisfaction score was 4.4 out of 5, with nearly 82% of respondents saying their virtual visit was as good as an in-person visit with a clinician. In fact, more than half of the respondents agreed that their virtual visit was better than an in-person one.  Read More

• CMS has unveiled a new value-based payment model seeking to reduce health disparities in end-stage renal disease. The model is part of CMS' proposed ESRD prospective payment system rule and would modify the current ESRD Treatment Choices Model's benchmarking and scoring methodology to try to incentivize dialysis providers to lower disparities in home dialysis and kidney transplant rates among patients from disadvantaged communities.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.

Here's The Latest in Health Care:


After a year of significant disruption, U.S. physician groups are starting to see signs of financial recovery according to a new report from Kaufman Hall. Physician groups across the country continued to see key performance metrics return to near pre-pandemic levels in the first quarter of 2021, suggesting an end in sight to the volatility driven by COVID-19 that rocked practices throughout 2020.  Read More

Some experts argue that in order to achieve alternative payment models that improve care quality and yield lower costs, payers may need to implement patient-centered models designed by physicians. Moving away from a one-size-fits-all APM model and focusing on condition-based models that include a variety of inpatient and outpatient treatments and procedures can reduce barriers and improve costs and patient health outcomes.  Read More

Independent physicians are becoming increasingly rare in the United States. A new report revealed that hospitals and corporate entities, which include insurers or private equity groups, now own nearly half of the physician practices in this country and employ nearly 70% of U.S. physicians.  Read More

Physicians spend significant time performing nonpatient-facing tasks like documentation, that are necessary but ultimately take time away from one-to-one patient care. Technology solutions, such as those powered by artificial intelligence, can reduce the amount of time spent away from the patient, vastly improving both the patient and physician experience.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.
Ensuring a clean claim to avoid denial

 

Before we dive into charge lag and reconciliation in the revenue cycle process, we need to first understand the basic life of a claim. In its simplest form, the life of a claim goes: 

1) Charge capture - a provider sees a patient and records the services rendered.

2) Coding - The charges are reviewed for accuracy prior to sending out the “clean claim.” Note, missing documentation or physician queries can lead to coding lag.

3) Claim submission - The clean claim is sent to the patient’s insurance company.  Any edits with the payer or additional claim edits can also delay claim submission. 

4) Payment posting - Payment is received from the payer, which can also include denials or requests for additional information. 

5) Collections - The remaining balance owed by the patient is collected.

What is charge lag?


Charge lag is calculated by the number of days from the date of service to the date charges are entered. Ideally, charges should be entered within 24 hours of the date of service, but that’s not always the case. In fact, a 2019 survey revealed only 32% of respondents indicated their charges are captured in 24 hours, while 35% said it takes 3-7 days, and 6% reported taking more than a week.

The negative impacts of charge lag


As the first step in the life of a claim any charge lag can significantly delay everything that comes after it. Therefore, charge lag ultimately leads to delays in reimbursements, a.k.a, it takes longer to get paid. For example, if charges aren't captured within 24 hours, it can cause delays in claim submission, which then causes delays in reimbursement from insurance, especially if there are any follow-up and/or additional requests from the payer. Many payers also have strict deadlines for when claims and/or additional information must be submitted after the date of service, which can lead to underpayments or denials if the charge lag is significant. This can result in appeals and unnecessary follow-up, which can be incredibly time-consuming and costly. 

So for instance, if a provider bills a 99291 for initial critical care, payers may request to review medical records to finish processing the claim. But if the charge lag was high to begin with it could result in the inability to get documentation submitted in time. At that point, payers can change the code to 99233, which is a subsequent inpatient code. This can be the difference between being paid $104 instead of $220, which is more than a 50% reduction. Or, the claim could also deny altogether for untimely filing with zero reimbursements; all caused by the initial charge lag. Depending on the insurance company, timely filing can be as little as 60 days from the date of service.

What is charge reconciliation?


Charge reconciliation is the act of comparing charges captured to the services provided. It is an important process within a health care organization's revenue cycle to ensure consistent, timely, and accurate charge capture and resolution of pending charges.  Completing regular charge reconciliation helps identify root cause issues that can lead to delays in reimbursements and denials.

Best practices for charge reconciliation


Good charge reconciliation can reduce charge lag and increase revenues overall. Here are a few tips to set you up for success:

*Establish a standard of acceptable lag limit when entering charges,
*Reconcile frequently and track missing charges, 
*Maintain and track the charge lag report,
*Educate providers on missing charges that are identified. 

In pMD, you'll find all of the reporting tools needed to help audit, reconcile and educate. 

If you are interested in learning more about pMD’s Billing & Revenue Cycle Management Services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

Related Articles:

Charge Lag Statistics: What to Look for When Evaluating Charge Capture

Custom Medical Coding & Billing Solutions – pMD, Your Coding Assistant

Electronic Health Records Don’t Reduce Administrative Costs - Mobile Charge Capture Does!




To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

 

Here's The Latest in Health Care:


The new CMS data interoperability rule will take effect on July 1st, which aims to free data from silos to promote interoperability between payers and providers. The mandate represents a step forward for patients being able to access insightful, actionable health care data in a timely fashion, so they can make better decisions about their health. Good health information exchange can also reduce the burden of certain administrative processes, such as prior authorization.  Read More

When looking at hospital-insurer contracts, researchers found that fixed-rate contracts correlate with lower costs and prices compared to discounted charges contracts. To evaluate the relationship between hospital-insurer contracts and hospital performance, the study looked at general acute care hospitals and noted the different types of contracts as well as outcomes such as prices, costs, charges, and length of stays.  Read More

While the covid-19 pandemic has taken an incredible toll, we’re starting to see a few positive side effects that could have lasting implications. The pandemic has given us a glimpse into the emergence of a new kind of patient, one that is more engaged and active, and who has the potential to drive improved care for decades to come.  Read More

Amazon's cloud division launched a health care accelerator to boost startups' growth in cloud technologies and enable early-stage companies to tap into AWS' technical and commercial expertise. The program will focus on technologies such as remote patient monitoring, data analytics, patient engagement, voice technology, and virtual care.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.
Vendors that are strategic partners

 

In this day and age, so much of what traditionally needed to be done in person can not only be done virtually but has become the standard in many cases. Whether it’s school, work, or even just catching up with family and friends, it seems like almost everything we can think of can be done remotely.

A generation made for telehealth


Although, as a society we’ve been slowly moving towards having more regular virtual interactions for a while, this phenomenon has been greatly accelerated by the recent pandemic, leading to an increase in the usage of telemedicine specifically. While this represented a monumental shift in how care is delivered, especially for older generations, it was far less of a foreign concept for Generation Z (Gen Z), who were essentially born with a smartphone in hand and have never known life without the internet. Gen Z, which are those born between 1995 and 2012, is expected to account for an estimated 61 million new employees in the global workforce in the next decade, and for them, Telehealth isn’t something they are hoping will just pass with the pandemic. 

Is the office visit dead?


Hold on, let’s not go that far! There are certainly plenty of instances where a telehealth visit with a doctor just won’t cut it. But, ask your average 18-25-year-old if they have a choice to physically go into a doctor's office or connect with them virtually, which would they choose? Chances are they won’t be so hesitant to take the virtual option. In fact, according to a recent study,  41% of Gen Z would actually prefer receiving their health care consultations digitally rather than in person, by far the most of any generation. At the end of the day, telemedicine provides both patients and providers increased flexibility and efficiency, both of which are coveted highly by Gen Z. 

What about privacy?


Since they’re already so used to having so many of their daily interactions online, Gen Z tends to hold a much different view about digital data privacy compared to older generations. When it comes to where they find and consume their information, a majority of Gen Z rely on a variety of different sources such as their cell phones, social media, and YouTube channels to stay informed on the subjects of interest to them. Most of these platforms require their users to share their personal information online, which is one of the main reasons why Gen Z feels more comfortable providing their data over the Internet. Because of this, many of the individuals from the younger generation seem to be much more willing to share their personal health information online compared to older generations if there is a clear benefit to them. With the increase in social distancing measures due to the pandemic and the ability to fit their consultation within their busy school schedules, the younger generation feels much more comfortable using telemedicine because it suits their personal lifestyles better.

Why should we continue to embrace telehealth?


At the end of the day, Gen Z value having access to everything they need right at their fingertips. By making it easier for them to seek medical advice through telemedicine, we can encourage more Gen-Zers to feel comfortable speaking up whenever they’re dealing with any health-related issues and encourage them to meet with medical professionals regularly. Even though more serious procedures may still require them to visit a doctor in person, there’s still a benefit in giving them the option to have their initial conversations virtually. Ultimately, it’ll be able to make their lives easier and make it more convenient for them to seek medical attention when needed.

If you are interested in learning more about pMD’s telehealth tools and services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

Related Articles:

The Case for Mobile Based Telehealth
Long-Term Telehealth Workflow Best Practices
Measuring the Impact of Telehealth: What to Measure, Why & How


To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealth, secure messaging, clinical communication, and care navigation software and services, please contact pMD.

 

Here's The Latest in Health Care:


Providers widely anticipate telehealth use will grow after the pandemic. But for these solutions to be optimized and not just utilized, regulations must align. Barriers to optimizing telehealth solutions were abundant prior to the pandemic, but many regulatory flexibilities, including equal reimbursement and relaxed HIPAA regulations, allowed use of the technologies to take off.  Read More

The country’s largest physician organization is taking steps to rein in bureaucratic prior authorization requirements that can lead to delayed and disruptive treatment for patients. At a meeting this week, the American Medical Association’s (AMA) delegates adopted new policies specifically targeting peer-to-peer review of prior authorization decisions and the particular burden of prior authorization during a public health emergency.  Read More

After modest uptake for nearly three decades, hospital at home programs are now growing faster across the country due to the coronavirus pandemic, which has improved reimbursement for hospital at home services and opened up opportunities for virtual hospital at home programs. But, selecting appropriate patients is one of the keys to success for these programs to thrive.  Read More

Health care has remained a top target for cybercriminals and as attacks become increasingly more disruptive, many providers are still struggling to understand the threat landscape and just what security measures to prioritize. It’s become increasingly clear that there is no silver bullet technology to completely protect a health care organization. Providers must instead prioritize proactive policies and plans to better defend their networks.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.