The pMD Blog

Welcome to the
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.

Increasing medical practice revenue


Last month, we took a look at three ways to increase medical practice revenue. Today, we’re going to look at a few more!

We’re nearly three-quarters of the way through 2021, and though we’ve been able to adapt to many of the ways the COVID-19 pandemic has altered the medical landscape, we are not out of the woods yet, and neither is your practice revenue

PATIENT OUTREACH:

A recent study found that one in five adults delayed seeking medical care due to the pandemic. There are multiple factors that could have contributed to this: apprehension from being exposed to the virus, financial challenges, and difficulties in accessing care.

You may have patients who, despite potentially having conditions that need treatment, are anxious about resuming their usual medical care due to fears about their safety or even concerns over the availability of appointments.

Establishing an open line of communication with your patients, along with keeping them informed of their care options, will help reassure patients that they are your top priority. Make patients aware of any available appointment openings, how they can utilize telehealth, as well as the precautionary measures your practice is currently taking to keep them safe. Give them the opportunity to reach out to your staff to discuss their current financial situation, and what they can expect if they choose to resume care. A great patient experience can lead to stronger patient retention as well as a higher likelihood of on-time payments. 

CLAIMS INVESTIGATION:

As discussed in our previous blog, you don’t want to sit on unpaid claims from insurance carriers. Remember to diligently follow up on any denials, and make sure bills are submitted by your billing team daily. A faster turnaround leads to faster payment!

Much of your revenue is going to come from insurance payments, so it’s essential to ensure that you and your team are staying on top of it. Experts recommend having staff members take ownership over outreach with insurance carriers they have experience working with so that it’s easier to delegate claims investigation and ensure that the workflow is organized efficiently. Don’t just have them re-submit a rejected claim to an automated system. You’ll want to confirm what the carrier needs from you to ensure that this time, your submission will be accepted.

The last thing you’d want is a rejection to be accepted by your practice at face value and to have that total forwarded to your patient. Studies have shown that unreasonably high bills can cause patients to distrust their medical professionals, even if the practice had nothing to do with allocating the bill itself. Practices benefit more from large insurance sums than from expecting their patients to cover the total alone, plus it prevents patients from feeling that the practice isn’t looking out for their best interests. 

ONLINE COLLECTION

Modern patients want modern solutions. Your average American already uses their phone to order rides and meals, as well as to pay their bills. They want convenience, so why not make paying their copays and medical bills just as easy? 

Although older patients may be more comfortable paying an individual directly or even sending a check, younger generations are more accustomed to making all of their payments online. Giving patients the ability to make payments more quickly, and in a format that they trust, provides a faster and more instant payment turnaround for your practice.

A payment platform also gives patients the ability to confirm their current balance with their own eyes and provides immediate verification that their payment has been processed. Setting up payment plans then becomes simpler and easily automated. Instead of navigating through transferred calls and mailed paperwork, patients have the control to handle their medical finances the same way they handle all their other expenses.

pMD’s billing service has found ways to streamline and enhance the billing and payment workflow, giving providers and patients more control over their respective processes. Contact us today and learn how we can help you improve practice revenue!

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 American Medical Association (AMA) released updates to its medical codes for 2022 with many tied to new technology services and the administration of COVID-19 vaccines. The more than 400 changes include a series of 15 vaccine-specific codes the AMA considers the model for efficiently reporting and tracking immunizations and administrative services against the coronavirus.  Read More

Even though telehealth volumes are expected to decline in the coming months, a recent survey found that many health systems are planning to expand their telehealth services. Chronic care management, behavioral health, and urgent care were the top three service lines cited by survey respondents for the future expansion of telehealth.  Read More

HHS announced the first part of the Surprise Billing Final Rule effective January 1, 2022,  but implementing the requirements under the No Surprises Act is no small feat for provider organizations. Providers need to ensure they are prepared to implement the act in order to uphold these protections and eliminate cost-of-care burdens for their patients.  Read More

The COVID-19 pandemic spurred health systems to adopt new technologies and meet the changing needs of their patients. However, according to Kaufman Hall, greater focus and investments are required for hospitals to compete with heightened consumer expectations, hospital competitors and an expanding list of retail and technology companies entering the space.  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


Here at pMD, our passion is applying technology to improve health care delivery and billing. Natural language processing, often abbreviated as NLP, is a class of technology with enormous potential for integrating into all aspects of health care. We’ll discuss the current state of NLP, its potential use in health care, and the challenges that lie ahead.

What is Natural Language Processing (NLP)?


To understand Natural Language Processing (NLP), we must first understand the definition of natural language. Put simply, natural language is anything that people use to communicate with each other. This includes spoken language as well as written forms of language such as letters, emails, and text messages.

Natural language processing is then exactly what it sounds like: processing natural language for useful insights. In other words, NLP can be thought of as a pipeline. The beginning of the pipeline starts with the unprocessed natural language, and the product of the pipeline is the output of useful information for interpretation or analysis. The difficulty of NLP lies in the middle stage of this pipeline: engineering algorithms that are capable of processing the nuance of natural language into useful insights. As this is such a broad definition, everything from the humble autocorrect to sophisticated products such as Siri and Google Translate can be categorized as NLP.

Current Applications of NLP to Health Care


Current applications of NLP to health care remain limited but promising. One type of NLP technology is speech-to-text. Providers speak into a dedicated device or mobile app, which records their voice. Then, either a human scribe or an automated voice recognition algorithm will transcribe their spoken words into text. This allows them to “write” documentation or messages much faster than typing. A natural evolution of this technology is the digital scribe, a program that not only records what the provider is saying but also analyzes entire provider-patient encounters to generate a condensed report.

On the documentation and billing side, NLP has found applications as well. One major area of application is EHR verification. Algorithms can scan through clinical notes and attempt to determine whether the provider’s documentation is sufficiently detailed. On the billing side, computer-assisted coding can perform a similar function by scanning documentation for billing-related information. These programs can help billers faster parse through long notes and suggest potentially billable codes.

How do these applications benefit health care? Firstly, they have the potential to provide a better patient experience by freeing the provider from staring at a screen. A fully operational digital scribe would handle documentation, allowing the provider to focus on the patient. Additionally, NLP products can streamline practice workflows, whether on the clinical or billing side. EHR verification can automatically flag missing information for correction, while computer-assisted coding can accelerate the billing process.

The Road Ahead for NLP in Health Care


With much of NLP, the challenge lies in finding ways to analyze the nuances of natural language with algorithms. Although great strides have been made in improving machine understanding of natural language, there are still numerous problems with reliability as well as concerns about cost and interoperability. Ironically, many of the tasks described in this post would be relatively simple, albeit tedious, for somebody with medical knowledge. With NLP, the hope is that technology can offload the burden of these tedious tasks and allow clinicians, billers, staff, and patients to focus on health care.

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:


Physician practices are up against a changing healthcare environment and one that has made it harder to survive. Declining reimbursement rates, industry consolidation, and new sites of care delivery are among the latest trends impacting practice management. Practice management best practices can help leaders continue the delivery of high-quality, affordable care while ensuring they can keep the doors of their small business open.  Read More

Reducing the length of stay (LOS) became a major priority for hospitals during COVID-19, and continues to be one as surges continue. Pandemic aside, capitated reimbursement levels and the need to decrease hospital-acquired conditions made LOS reduction key for health systems. While efforts to reduce LOS often focus on specific disease classes, there are general operational factors that are more straightforward to address.  Read More

New research shows that 79% of people who received healthcare services in the past two years experienced an average of three challenges when doing so. Struggles ran the gamut from administrative issues to understanding the care they received itself. Plus, 90% of respondents with complex or ongoing clinical needs faced additional challenges related to tasks such as getting prior authorizations approved.  Read More

The rapid expansion of telemedicine during the pandemic made headlines. What has been overlooked are the changing patterns of its use. According to a recent analysis of 30 million medical claims, which older adults used telemedicine, and how they used it, did not play out exactly as many had expected. Moving forward it will be essential to closely track the evolving use of telemedicine — and which Americans can access their care this way — to ensure that telemedicine does not widen disparities of 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.

Here's The Latest in Health Care:


A new analysis found that over 100K COVID-19 hospitalizations could have been prevented with vaccines, resulting in billions of dollars in costs for the US health system. With the approximate cost of a coronavirus-related hospital admission being about $20,000, researchers estimated that these preventable COVID-19 hospitalizations cost the US health system $2.3 billion in just June and July alone.  Read More

CMS is encouraging all Medicare Advantage organizations and Medicare-Medicaid plans to waive or relax certain prior authorization requirements amid the COVID-19 surge. In a recent letter, CMS asked these health plans to relax the requirements to facilitate the transfer of patients from acute-care hospitals to post-acute and other clinically appropriate settings.  Read More

At the start of the pandemic, emergency declarations and insurer policies encouraged the shift to telehealth. Telehealth usage has skyrocketed, often leading patients to grow accustomed to relying on virtual care for its convenience and cost-efficiency. Now, as states across the U.S. are putting an end to these policies, telehealth meets one of its biggest hurdles: geographic barriers.  Read More

Hospitals and health systems’ economic recovery hit the brakes in July with mounting COVID-19 admissions, escalating expenses and early evidence that consumers are again postponing elective and outpatient care. Not surprisingly, hospitals in the regions with the highest rates of the variant were most affected in July, and are expected to see those impacts deepen in the months ahead.  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.
Increasing medical practice revenue


Medical practices can measure success in many different ways. When it comes to revenue, an upward trend is definitely a positive thing. There are actions a practice can take to ensure they don't see their revenue plummeting towards the point of no return. Here are 3 proactive approaches to increasing your medical practice revenue.

Provider Credentialing:


Medical credentialing is a crucial process in relation to the claim life cycle, but why? Credentialing is the first step in establishing a contract with the payer. By enrolling as an in-network provider, you can now leverage your agreements with the payer to ensure that you are reimbursed for your services and at the proper contractual rate. Without it, your practice risks losing thousands to hundreds of thousands of dollars in revenue per year as a result of denied claims or delays in adjudication. If you neglect your credentialing or make the slightest mistake on your application, you chance your enrollment being rejected and the consequences will be as severe as non-payment for your services.

Credentialing also opens up more opportunities for providers to expand their patient base. When credentialing with a payer, you’ll enroll with their networks, increasing the number of patients that now can be seen by your practice as “in-network.” This can have a direct impact on the number of referrals that you receive, which ultimately increases your revenue stream. Patients are more inclined to be treated by an in-network provider since it’s more cost-effective with less out-of-pocket expenses for the patient. The comfort of knowing that this provider has been vetted by the payer is also a factor that a patient takes into consideration when selecting a physician. 

You can begin by evaluating your local payers to determine which are worth pursuing contracts with. Although carriers will not disclose their fee schedule upfront, you can determine if that relationship will be beneficial based on the demand of your patient base. You have better odds of reimbursement as a participating provider. This will also put your practice at an advantage, allowing you to stay competitive across multiple avenues. You’ll find that if you’re growing your practice, physicians will be more likely to join a group with a larger network because of the benefits of credentialing. 

Physician Fee Schedule Negotiation: 


The next step is to evaluate the contractual rates assigned at the time of your enrollment. Many physicians do not bother to negotiate their rates as it can be another intensive process or they were simply unaware that this was a possibility. Great news - this is in fact an option and a great way to boost revenue for your practice!

When assessing your practice's financial health, it should be quite apparent where your revenue is generated from. Your financial reporting should identify your top paying carriers as well as your top-billed procedure codes. In pursuing higher reimbursement rates, you’ll want to begin by reviewing what the customary rate is for your region. You’ll then need to demonstrate the value that your practice can bring to the insurance network. One of the biggest factors to highlight is the cost savings you’ll provide due to your clinical outcomes. Another beneficial attribute is location and specialty. Is there a shortage of your specialty in the area? Will you continue to grow your practice consistently to offer a larger network for their patient base? 

Eligibility Verification:


Now that you have secured your contracts with payers and negotiated those contractual rates, your reimbursement will ultimately depend on the success of your eligibility verification process.

Unfortunately, many practices have experienced a scenario where the patient presented their insurance card, the billing department has submitted the charge to the carrier, and you later learn that the claim has been denied due to “subscriber not found” or “provider out-of-network.” Where do you go from here? Did your front office have the patient sign a waiver, such as an Advance Beneficiary Notice to allow you to legally bill the patient? Do you attempt to bill the patient and still run the chance of not getting reimbursed as the patient is unable to afford the balance? These are the challenges and tough decisions providers face when not validating the patient's insurance prior to the visit.

Luckily, these scenarios can be prevented by verifying the patient's coverage ahead of the appointment. Implement a streamlined process that will allow you to check eligibility electronically. If you decide not to use an electronic eligibility solution, the alternative will require your staff to spend countless hours calling various payers and will likely result in missed eligibility checks, inaccurate responses, or limitations to the data that can be provided. Not to mention, some serious overhead costs.

By integrating with an electronic solution, you can identify the specific health plan the patient is enrolled in and therefore determine provider participation status. You’ll also identify the patient’s out-of-pocket expenses, such as the remaining deductible prior to treatment. This enables you to leverage these responses to collect the patient's copay or deductible at the time of the appointment and in doing so, eliminate lag time in patient collections as well as prevent those dreadful denials. 

Running eligibility prior to a visit is a critical piece to ensuring your practice will be reimbursed for the services you’ve rendered. You’ve dedicated your time and hard work conducting your visits, let’s not let coordination of benefits stand in the way of you getting paid. Getting the eligibility responses is one thing, interpreting those responses is another. It’s possible that the insurance coverage will return as active but the patient’s primary plan is covered through what is considered an “Advantage Plan” and you may not participate in that network. 

Expertise & Services to Help Increase Medical Practice Revenue:


In all three scenarios, enlisting experts to help guide you through the credentialing, fee schedule negotiation, and eligibility processes as well as help identify key factors and trends is essential to seeing your revenue maximized. Here at pMD, our expert team provides you with the services and experience you need so you don’t have to navigate all this on your own. We offer free consultations and would be happy to evaluate your financial analytics to help maximize revenue for your practice!

Related Articles:

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 nurse practitioners (NPs) has grown rapidly in recent years to meet the growing demand for providers. Over the past two years alone, the number of NPs jumped from 270,000 to 325,000. This massive growth has had a huge positive impact on the availability of care, especially for patients who are underserved or wouldn't have full access to care otherwise. In 2020 alone, NPs across the United States had more than 1 billion visits and are changing healthcare for the better.  Read More

After an exhaustive review of the Center for Medicare and Medicaid Innovation’s (CMMI's) more than 50 models, CMS leaders found major challenges in setting benchmarks that determine cost-saving goals for payment models, and providers find it difficult to accept a financial risk without flexibility for caring for certain populations. As a result, CMS has outlined reforms to benchmarks and financial incentives in order to entice providers to participate in the models.  Read More

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration have both approved additional vaccines for people with suppressed immune systems. Now, healthcare providers plan to incorporate the distribution of an additional dose of COVID-19 vaccine to immunocompromised individuals with their existing vaccination campaigns—and as preparation for future efforts to get extra doses to a larger share of Americans.  Read More

This year at HIMSS experts shared their thoughts on a variety of topics, including the future of digital health, artificial intelligence, and virtual care; methods to tackle health disparities and cybersecurity breaches; evolving fraud regulations; mental health, and much more. But one thing was constant. COVID-19 was the strain running under it all, as attendees focused on how the sea changes brought from the pandemic will reverberate in healthcare for years to come.  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.
Patient experience and revenue cycle management


Successful revenue cycle management, or RCM, can mean a lot of different things: financial stability, increased revenue, and reportable data. From submitting claims to collecting payments to reporting, practices rely on this process and its resulting data to help them identify trends and make important business decisions. But there is one essential factor to the success of RCM that is often overlooked and that’s the patient experience. We don’t inherently lump patient experience with financial upside, so why is it so important to RCM?

The patient experience cycle


When we think about the patient experience, we often limit its range to the visit itself or the care received. But what we don’t realize is that, more or less, there are multiple points of interaction outside of just the face-to-face encounter with a provider. From the time an appointment is scheduled to when the patient pays their bills, the quality of the patient experience depends on how smooth the process is at every point of the cycle. 

The patient payment process can be a particularly challenging one to navigate for many reasons. In some instances, patients are faced with paper statements that may arrive late in the mail or are possibly overlooked. Then, the patient would still be required to call the doctor’s office to make the actual payment via credit card or worse, would have to mail a check. Now imagine being able to receive statements via text or email and having the option to pay directly from there, or even at the point of service. Patients aren’t concerned with whether or not the practice is using an in-house versus outsourced biller nor do they really have visibility into such things on the backend. So, when it comes time for a patient to pay their medical bills, if the front end process is disorganized, unclear, or difficult in any way, you can bet the patient's experience suffers and the onus of that bad experience often falls squarely onto the practice, undoing all the hard work and thought put into providing great medical care.

Keeping the patient experience top-of-mind


Every step of the patient cycle plays a key role in providing a positive patient experience - appointment reminders, patient intake, gathering financial and insurance information, the encounter with the provider, the payment process - all of these combined make a strong case for a good experience, should everything go smoothly. Things like no-shows due to a lack of appointment reminders or sending paper statements that cause delays in timely payments can hinder not only a good patient experience but also the chances of collecting payments in a timely manner, if at all.

As a practice, it’s easier to provide that seamless experience when everything you need is in one place. At pMD, we care about what you care about. We’re a team that’s invested in the things you’re invested in. So naturally, your patients are our top priority. Our revenue cycle management service allows you to provide that top-notch patient experience while also seeing your revenue increase. Let us take care of the administrative work so you can focus on what matters most.

Related Articles:

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:


A prohibition on surprise billing is coming at the start of next year and federal agencies have started to release what surprise billing compliance will look like. These new compliance requirements will have a major impact throughout the revenue cycle, directly impacting workflows from admissions to billing, so preparation now is key to meeting the January 1, 2022 deadline.  Read More

Analysts believe Healthcare employers must consider how to make front-line caregiving a more sustainable career, and more specifically, how they'll leverage technology to do so. Healthcare employers may need to rethink the roles and duties of their workers now, if they haven't already, and can start by asking how we work, where we work, and what skills we need.  Read More

The impacts of downgrades from inpatient to observation status can have far-reaching financial repercussions for healthcare providers, affecting reimbursement and revenue recognition. But there are actionable steps for mitigating status downgrades and dealing with them effectively to ensure that organizations receive the full reimbursement for the services they provided.  Read More

The benefits of telehealth have become widely known here on Earth, and it's been an increasingly accepted treatment modality for patients during the pandemic. While the ailments, approaches and technology may be a bit different, telehealth is alive and well aboard the International Space Station as well. It's become a lifeline for astronauts and in some ways, low-Earth orbit has been ground zero for telehealth.  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:


CMS recently released four final Medicare payment rules for the 2022 fiscal year. The rules cover newly increased rates and other policies for skilled nursing facilities (SNFs), hospice agencies, inpatient rehabilitation facilities (IRFs), and inpatient psychiatric facilities (IPFs).  Read More

Telehealth use has significantly helped cut down on the number of low acuity emergency department visits, helping address a persistent problem that hospitals have faced for years. According to a new survey, nearly one in seven people who used telehealth said they would have gone to the ED or urgent care if the service was not available.   Read More

According to a new study, hospitals with a higher share of Medicare patients had lower profits and were more likely to be acquired or close compared with hospitals less dependent on Medicare.  Read More

Healthcare data breaches are on the rise. A recent breach report highlights the fragility of our online infrastructure and found that the COVID-19 pandemic has presented a wide range of vulnerabilities for bad actors to take advantage of. In fact, the healthcare industry experienced a more than 50 percent increase in the total number of patient records exposed compared with 2019.  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.