The pMD Blog

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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.

Increasing medical practice revenue


When your life depends on it, do you want the opinion of one specialist or the combined opinions of many? The ‘many’ option seems more appropriate.

IT'S NOT YOU, IT'S ME 


Second opinions are all about advocating for your own best health care options. According to one study, 66% of second opinions resulted in better-defined diagnoses and 21% resulted in completely different diagnoses. Having the ‘second opinion’ conversation early, before treatment begins can ensure the correct treatment plan, correct diagnosis, and avoid unnecessary costs as well as unnecessary tests and procedures. 

CAN I JUST START SEEING SOMEONE ELSE?


Typically, most providers and many insurance companies require or prefer a referral from your physician. The most efficient way to get an appointment in this century is to have your current provider make a referral on your behalf. Peer-to-peer referrals allow providers to quickly share the necessary details, as well as safely and securely transmit any of your diagnostic tests. In a perfect world, it’s a quick phone call and an electronic handshake, followed by a call to the patient from the central registration department to gather the required demographic and insurance info if your referral will be outside of your current health care system.  

WHY ONE PROVIDER CAN’T BE OUR EVERYTHING


There is this unspoken unreasonable expectation that we place on our providers. Why do we expect them to know everything and be everything to all of us? Providers, just like us, are a product of their environments, their education, and their social and professional networks. We impose an unnatural expectation on them that they are all-knowing and without flaw. Why can’t we shift our mindset and encourage them to connect and communicate better, without judgment? Remove the expectation that they must know all and replace it with an expectation that they will simply help each patient intelligently navigate finding the right answer, the best treatment, and the right provider. Patient outcomes improve when we create health care cultures that promote sharing and discussing differing perspectives, as well as cultures that are receptive to differing perspectives. It’s a two-way street. 

CAN WE ALL JUST GET ALONG?


What is our role as a health care technology vendors and communication facilitators? Shouldn’t our providers have a world of specialists at their fingertips? Is it too much to ask for a built-in network for providers to openly communicate and advise each other? It's not too much to ask for. Science and technology have taken us so far. We can photograph galaxies 13.4 billion light-years away, but we have yet to normalize private community chat rooms and instant messaging for health care providers. Perhaps the most impressive advance in health care technology is simply free and open communication amongst the provider community itself. 

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:


It was another tumultuous year for the revenue cycle, from the slow burn of price transparency and the fight over surprise billing, to the renewed focus on the workforce, not to mention the continuing COVID-19 pandemic. These are three issues that defined 2021 for the revenue cycle.   Read More

With the goal of offering a unified method for representing mailing, physical, billing and other addresses, to help improve patient matching, the Office of the National Coordinator for Health IT released the Project US@ (pronounced "Project USA") Technical Specification Final Version 1.0. The new specification was developed as a unified, cross-standard approach that can be implemented across healthcare organizations of all shapes and sizes.  Read More

Hospital mergers and acquisitions were down in 2021 as industry leaders faced another year battling the COVID-19 pandemic, new research from Kaufman Hall shows. While the number of hospital mergers and acquisitions remained low, the size of those few announced transactions was significantly up, researchers reported. But while the number of hospital mergers and acquisitions remained low, the size of those few announced transactions was significantly larger.  Read More

As the pandemic made scheduling medical appointments harder and continued to strain an overburdened healthcare system, some patients are turning to do-it-yourself care at home. Patients are increasingly turning to home testing kits, gadgets and health monitoring apps to manage their health, track their blood sugar and cholesterol levels and even conduct electrocardiograms.  Read More

Every other 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.
Increasing medical practice revenue


There is a lot of room within health care to optimize processes and improve the patient experience. What’s a thoroughly tested, universally used, and applicable method that could accomplish this? Gamification.

What is gamification?


Gamification is the process of applying game techniques and elements in a non-game context.

So, no, we’re not suggesting making doctor visits into a video game, but rather borrowing principles of gamification and psychology and applying them to improve a patient’s experience and engagement with the health care technology they’re using.

Ok, but how does it work?


Gamification triggers emotions that are linked to a positive user experience. Within apps and websites, this usually looks like encouraging users to gain more points, rewards, or discover more information. Users like having (or at least the illusion of having) control. They like to feel a sense of achievement when they correctly complete a task on a platform. Our human instincts and curiosity drive us to explore and want to escape into a virtual world, which is one of the many reasons why video games are so effective. Gamification can also help establish a match between the system and the real world, one of the 10 foundational heuristics of user experience design. When a design speaks a user’s language, using words, phrases, and concepts that are familiar to the user, it’s easier for the user to learn and remember how the interface works and builds an experience that feels intuitive.

What does this look like in a health care setting?


One area that could significantly benefit from gamification is telehealth. Telehealth use is 38 times higher than the pre-pandemic baseline but this dramatic shift hasn’t given the user experience a chance to catch up. Currently, patients are being asked to join a “waiting room” that consists of a blank white screen, or end up staring back at a reflection of themselves until the provider, without warning, joins the call to start the visit.  

Patients have no way of knowing if the provider could be running behind or how long they have to wait. They don’t know if they can leave the website or app and are left to navigate an unfamiliar space. Imagine the difference even some basic imagery could provide. 

By providing patients with waiting rooms that not only mimic the real world more closely but also provide them with something to interact with while they wait, it can offer a greater feeling of control and provide a more positive experience. 

An interactive virtual waiting experience affords a lot more clues to the user about the fact that they are in a waiting room (match between system and real-world), how much longer they need to wait (sense of control), and gives them the option of exploring and engaging in activities (we love to explore and escape). A gamified virtual waiting room experience could include things like giving the patient the ability to test their camera, writing a note to the doctor, interacting with a virtual front desk, etc. 

What more can gamification do?


Gamification techniques could further be applied to all different kinds of training for health care professionals, from learning how to use a new platform, to annual training, to learning how to perform a procedure. Gamification can even foster a sense of community and teamwork within a practice by incentivizing care teams to reach certain metrics together. The latter would have to be properly examined and implemented to avoid the platform becoming a “digital whip” for our essential workers.

In a nutshell


Health care gamification has the potential to significantly improve patient experience and retention with telehealth, as well as improve training, information retention, and engagement for health care professionals. Game on!

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:


Hospitals and other corporate entities now own about half of all U.S. physician practices. However, the acquisition of independent physician practices by hospitals, a trend that has accelerated rapidly in recent years, is actually linked to a modest drop in doctor compensation according to a recent report. These findings contrast with evidence that hospital systems' profits tend to increase as prices and spending rise after the integration of physician practices.  Read More

Roughly 40% of U.S. healthcare payments were tied to alternative payment models (APMs) last year, with Medicare Advantage claims representing the largest amount. According to researchers, the survey shows limited progress in moving away from fee for service between 2019 and 2020.  Read More

HHS is now distributing $9 billion in payments to healthcare providers affected by the COVID-19 pandemic. The funds will be split among more than 69,000 healthcare providers with the average payment for small providers being $58,000, while the average payment to large providers is $1.7 million.  Read More

The COVID-19 pandemic had a dramatic impact on U.S. healthcare spending in 2020, according to a report recently released by the CMS Office of the Actuary. The report found that U.S. healthcare spending increased by 9.7 percent last year to $4.1 trillion, which breaks down to roughly $12,530 per person. As a result of the sharp increase, healthcare’s share of gross domestic product (GDP) experienced a historic increase from 17.6 percent in 2019 to 19.7 percent in 2020.  Read More

Every other 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.
Increasing medical practice revenue


The financial process health care facilities and groups use to submit claims to an insurance provider is known as your Revenue Cycle. This can begin well before a patient steps foot in the door and can continue past the final payment of a balance.

What is Revenue Cycle Management?


Revenue Cycle Management (RCM) refers to the process of identifying, collecting, and managing the practice’s revenue from payers based on the services provided. A successful RCM process is essential for a health care practice to maintain financial viability and continue to provide quality care for its patients.

The Revenue Cycle can look a little something like this:

1. Before a patient arrives for inpatient or outpatient procedures, collect any pre-registration information, such as insurance coverage.
2. Collect subsequent patient information during registration to establish a medical record number and meet various regulatory, financial, and clinical requirements.
3. Complete charge capture, which refers to rendering medical services into billable charges. This is what pMD has specialized in for over twenty years!
4. Have a coder review diagnoses and procedures.
5. Submit charges of any billable patient interactions to insurance companies.
6. Afterwards, the billing department can determine patient balances and collect payments.

This is a process where there are a lot of opportunities for hiccups and stalling. What if a patient’s demographic or insurance information was transcribed incorrectly, or a procedure is billed that doesn’t fit coding criteria? What happens when a claim is denied? How often is a patient left completely in the dark until the moment they get a massive bill in the mail? 

Here are some ways to mitigate potential hurdles and ensure that your RCM is benefiting your practice as well as your patients.

1. Maintain a clear line of HIPAA-compliant communication between different individuals in your Revenue Cycle. Ensure that if needed, it’s simple and efficient to verify the information required and receive updates as necessary.
2. Design a patient-oriented experience that prioritizes transparency. When you’re registering a patient, establish expectations with them, and keep them informed on what your staff is doing.
3. If your practice is verifying a patient’s insurance before a procedure, you can let them know if they need to pay a copay, or if they should expect to be billed a coinsurance. Confirming that their insurance will cover a high-cost operation will make it easier for your practice to collect payment, and put your patient’s mind at ease.
4. Provide relevant literature to patients who may require financial assistance. Ensure that they know their options regarding payment plans and if they can apply for charity or hardship.
5. Communicate clearly during the billing process, and ensure that a patient understands what responsibilities they have, whether they’re financial obligations or a need for documentation or additional paperwork.
6. Finally, you’ll want to make sure that your billing team has contact with the payers. Prompt, efficient follow-up is the best way to mitigate denied claims and decrease the turnaround time between submission and payment.

With these tools at your fingertips, you can ensure that your practice is run in a way that is both financially successful and compassionate to the needs of your patients.

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.
Increasing medical practice revenue


Payer policies are used to support coverage decisions and explain reimbursement for health care services to patients who are covered by a specific health plan. These policies outline whether providers are in-network versus out-of-network as well as how much is covered by insurance for things like office visits, surgical procedures, prescriptions, etc. Some payer names you may be familiar with are Medicare, Medicaid, UnitedHealth Group, Anthem, and Blue Cross Blue Shield. 

THE CHALLENGE WITH PAYERS


When navigating from one payer to the next, it’s important to know where the pain points are for your practice. I mean, let’s be honest, payers don’t make it easy for us. One of many challenges practices and physicians face with payers is rule inconsistency. Payers aren’t required to adhere to a single set of guidelines, allowing them each to create their own processes and policies. 

Another challenge practices face is that payers don’t even often adhere to their own rules when it comes to claim processing. For example, a payer that’s behind on processing may say that they didn’t receive the claim even though your practice is set up to submit claims electronically. Or a claim may be denied without the payer providing any explanation of what is needed to process the claim.

MONITOR YOUR PAYERS


So how do practices keep up with the changes without the headache? In a world filled with technology, take advantage of it! You can “like, subscribe to, or follow” payers in your region. Sign up to receive policy change notifications, newsletters, and bulletins through a payer’s website. You can also set a regular schedule to review payer websites. Focus on those pain point areas you’ve identified earlier. Were there changes in the process for authorizations, reimbursements, or coding? 

It’s important to prioritize knowing your payers. Review your high-volume payers and geographical regions. Then move on to looking at your practice’s high-volume services and identify what charge codes are being billed the most. Are the policies changing so frequently that they can result in denials?

TRAIN AND EDUCATE YOUR TEAM


It’s important to provide training and ongoing education across the organization as well as determine how payers will be monitored (i.e. splitting them up amongst the team).

Payer policy changes can have a lasting impact on your revenue cycle if you are not on top of denial management. Let’s strategize on how your practice can work efficiently and effectively to maneuver through payer obstacles. 

* Scrub charges prior to claim submission: think about utilizing software that is designed to prevent improper coding. If your software allows for it, create edits or prompts that prevent improper coding and allow a claim to be fixed prior to the submission process.

* Reports: create reports that provide visibility into charges and payers. For example, how many times is a charge code being reported by the payer? Is there over-utilization occurring? Reports can provide valuable insight into how payers are processing your claims.

You shouldn’t have to navigate these challenges alone. At pMD, we lift the administrative burden so you can spend time on what matters most. Our experienced revenue cycle management (RCM) experts integrate so tightly with your practice, it feels like we’re just down the hall. You take care of the patients while we take care of the rest! To learn more about pMD’s billing and RCM services, contact us today.

 

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:


The number of APIs that integrate with certified EHR technology is expected to continue to climb as more developers meet Cures Act requirements. As a result, it should start to become easier for patients to use smartphones, tablets, and desktop apps to access their personal health information from certified EHR systems.  Read More

Telehealth has become a common practice in the last couple of years, but the rules that temporarily eased licensing and reimbursement restrictions in ways that expanded the usage are rapidly shifting. For example, about half of all U.S. states have passed measures keeping audio-only telehealth in place, while the remaining states, absent legislation or old restrictions governing telehealth have either kicked back in or will sunset when the federal public health emergency ends.  Read More

Healthcare systems looking to remedy the fatigue brought on by unwieldy electronic health records systems and mounting staff shortages should explore how the integration of clinical communication and collaboration tools can modernize their workflows and ultimately enhance patient care.  Read More

Health systems are looking at remote patient monitoring as an emerging piece of the care delivery puzzle, but they need help embracing the strategy. Recent moves by the Centers for Medicare & Medicaid Services (CMS) to improve coverage are a step in the right direction, but experts say the effort is still very much a work in progress.  Read More

Every 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:


• In a recent study by Cigna, researchers found that patients who are diagnosed with a behavioral health condition and receive outpatient treatment have fewer visits to the emergency department or readmissions to an inpatient facility. This results in a lower cost for care per person per year.  Read More

• Nearly one in 10 children in the U.S. that are eligible to be vaccinated have received their first dose of the Pfizer COVID-19 vaccine. Children who received their first shot this week and their second three weeks later will be fully vaccinated by the Christmas holiday.  Read More

• This year marks the fifth consecutive year that the rate for improper payment for Medicare fee-for-service has been below the 10 percent threshold. This represents considerable progress toward a goal to protect CMS programs for future generations.  Read More

• According to a recent report, one of several findings surrounding home health care includes the fact that only 34 percent of hospitalized patients are sent to formal post-acute care settings, such as skilled nursing facilities. The rest are either initially sent home or to a retirement or assisted living community, contributing to higher hospital re-admissions.  Read More

Every 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:


Failing to support the acuity of the medical service rendered with coding and documentation is the number one reason payers deny a hospital claim over a coding issue, according to a new report. Other top causes for denials include if the procedure code is inconsistent with the modifier used or a required modifier is missing, the diagnosis is invalid for the date or dates of service documented, the diagnosis is inconsistent with the procedure, or the diagnosis was not covered at all.  Read More

Nearly one-third of older U.S. adults visit at least five different doctors each year, reflecting the growing role of specialists in Americans' health care according to a new study. On average, beneficiaries saw a 34% increase in the number of specialists they visited each year, while the proportion of patients seeing five or more doctors rose from about 18% in 2000 to 30% in 2019.  Read More

Providers are having a difficult time billing for services related to COVID-19, with 40 percent of charges for coronavirus-related care initially winding up as claim denials in the first 10 months of 2021, according to a recent analysis of more than $100 billion worth of denials and $2.5 billion in audited claims.  Read More

The Centers for Medicare & Medicaid Services has released the final physician fee schedule rule that sets out payment rates for 2022. In addition to including several provisions that aim to expand flexibility for telehealth reimbursement for mental health, including removing geographic restrictions, the rule will also let the 3.75% temporary pay bump given to physicians for 2021 expire.  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:


Hospital revenue cycle transformation is needed to elevate poor enterprise performance as a result of the COVID-19 pandemic, according to experts from healthcare management consulting firm Kaufman Hall. Three-quarters of hospital and health system leaders said their organization experienced “adverse revenue cycle impacts” during the pandemic, including a higher percentage of Medicaid patients and increased rates of denials.  Read More

While nearly 16% of doctors' visits by seniors were done remotely, either by phone or online over the past two years, the rural elderly appear to be behind the curve, according to a new analysis of telehealth visits billed to Medicare. One-third of rural older adults had at least one virtual visit in 2020, compared with nearly half of seniors in suburban and urban areas.  Read More

The majority of Americans don’t fully understand the information their provider tells them, leading them to consult third-party resources like the internet, a new survey found. In fact, according to the survey, three in four Americans leave the doctor confused and dissatisfied for reasons that include disappointment in the level of Q&A they have with their doctor, confusion about their health, and a need to do more research.  Read More

More physicians are migrating to hospital employment, changing the traditional physician-ownership models of ASCs. According to ASC leaders, there are a number of contributing factors, including the fear of declining reimbursements combined with the complexity of new payment models. Health care has become a "big cap" business requiring market scale, data analytics, and risk management, concepts that small practices are worried they can’t handle on their ownRead 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.