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POSTS BY TAG | Billing & Collections

Overview of Comparative Billing Reports

 

In 2010 the Centers for Medicare and Medicaid Services (CMS) began to release Comparative Billing Reports (CBRs). A CBR compares provider to provider billing practices, both regionally and nationally, to determine if a provider is an “outlier”, or billing outside of the expected pattern. If a provider is found to be an outlier, they will receive a notification detailing the analysis and erroneous billing, while offering education on the topic. CBRs review many areas of billing, and even topics outside of billing. Some common topics include; evaluation and management, modifier utilization, and groups of specific codes, for example, radiation modality treatments for oncology providers or dialysis visits for nephrology providers. It's also important to note that CMS is not the only one reviewing billing practices in this manner. Other large commercial payers have similar programs, such as UnitedHealthcare’s Peer Comparison Reports, which functions much like the CBR.

What is a CBR used for?


CMS and other payers perform CBRs and similar reports with the goal of providing educational resources and outreach. This outreach ensures compliance with coding and billing standards and reduces potential fraud, waste, and abuse. CBRs can also ultimately help patients. Most patients are unaware of the many coding and billing rules that exist and therefore have a difficult time identifying when they have been overcharged. This can lead to costly out-of-pocket expenses toward co-insurance and deductibles. Educating providers can offer a real impact on reducing a patient’s financial burden.

What should I do if I received a CBR?


While CMS says “receiving a CBR is not an indication of or precursor to an audit” the receipt of a CBR can still be a stressor, especially if a provider or practice does not have the right tools to internally investigate the CBR findings, or worse, does not know where to begin to address a CBR. The risk of removing focus from the patient care to address these billing practices is high. Additionally, ignoring the report altogether could place the provider and practice at risk for more CBRs in the future and even potential audits. CBRs should be promptly reviewed and addressed by taking the following steps:

* Examine the issue identified in the report closely
* Evaluate the organizations or individuals billing patterns as they relate  to the CBR subject
* Perform a root cause analysis and address or correct any errors with education
* Continue to monitor the situation closely

How do I avoid a CBR?


One of the best defenses for CBRs and other billing challenges is to practice proactive risk analysis, or regular and consistent monitoring to identify potential billing issues before they begin. Proactive risk analysis can easily be achieved by utilizing the data that already exists within your billing software. Reports that visually display information such as charge capture counts or evaluation and management level distribution can be particularly useful. The same reports can then be combined with CMS benchmarking data, allowing a provider or practice to easily identify any variance from expected billing patterns.

These reports should paint a clear and visible picture, providing valuable insight. In the event a CBR is received the reporting can be used as part of the examination and subsequent monitoring following education on the error. Reports can also be supplied to coding/auditing or Clinical Documentation Improvement Departments as a resource to begin analysis for targeted internal education.

Taking a proactive approach to billing patterns can effectively decrease billing errors, support operational excellence and allow providers to spend more time focusing on patient care, which is the heart of pMD’s mission.

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!

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.

 
Vendors that are strategic partners

 

In any given year, the changing healthcare landscape presents an ever-moving target. To keep up, busy practices may add a new vendor to address each problem they encounter. Further, on average teams with a clear goal may end up managing 3-8 vendors to execute that initiative fully. The result?  Teams became numb to the slow shift from managing priority problems to managing a growing list of vendors. 

Then 2020 happened. The disruption to clinic operation opened the eyes of many clinic operators and provided a unique moment of clarity. Looking at a laundry list of vendors to pay, teams were asking themselves difficult questions — how many of these relationships are essential? Which of these vendors are actually looking out for my business?


Teams turned the year poised to take more control in 2021. Seeking to reduce the risk that was exposed, clinic leadership has been actively consolidating the number of vendors they now manage. A recent technology industry survey reported more teams, nearly 10% greater than two years earlier, claim to now use up to 20 vendors. Further, fewer teams believe that it is easy to manage multi-vendor environments, down from 26% to 17%, while the number of those who see managing such an environment as “very challenging” has gone up by 8%. 

The benefits are clear and so the decision to reduce the number of vendors may be an easy one on paper. But the act of consolidating, and thus removing some vendors who may be performing a small task well, forces teams to look critically at the vendors they use today and to identify true strategic partners with which they will align for the future. 


Identifying Real Partners & Opportunities to Consolidate Vendors


A good first step to this process is to create and keep a vendor “score," routinely reviewing a vendor’s performance, grading them on key aspects of your relationship. Another good option is to review all your contract terms and establish a calendar reminder set for before that contract renews. Use those established timelines to investigate options to consolidate a current contract into a vendor who’s already performing well in another area and who may now offer a similar feature/service. As vendors expand their features and services to provide overlapping solutions, the opportunity to strategically consolidate vendors may be easier than you think.

But be mindful of the vendor’s ability to influence this trend. Some smaller clinical teams have shared that they may be facing fees upwards of tens of thousands of dollars to end an existing contract. Larger teams may face multi-million-dollar fees to end a relationship. These high fees can lead to inaction on the part of the clinical team and a lack of engagement with that vendor that has the compounded impact of complacency on the part of the vendor where the “chosen” vendor begins to lose their competitive edge. 

The Partner with Integrated Revenue Cycle Software & Services


When considering reducing the number of vendors you are managing, remember that the right partner should feel like an extension of your team. And any teammate needs to have time invested to fully realize all the benefits from that relationship. An integrated revenue cycle software and services partner like pMD pairs our team of national RCM experts and industry-leading software engineers to deliver control and ownership over revenue cycle metrics to prepare you for whatever the future may bring.

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!


 

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.

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Patient making payment using smartphone


Finances and the revenue cycle can be a high source of stress for providers, who let’s be honest, would much rather focus on patient care. However, effectively managing a practice's revenue is crucial to actually being able to continue to provide that care. One of the most unpredictable phases of the revenue cycle is collecting patient responsibility, which often results from the high variance in payment methods as well as hesitation to pay due to a lack of understanding of insurance systems. Simply put, many patients don’t know what they owe and why.

Why Is Collecting Patient Payments So Hard?


According to the American Association of Family Physicians, only 14% of adults understand key components of their insurance plans. This confusion and uncertainty can often make it difficult to determine a patient’s financial responsibility at the time of a visit, leading to even more frustration when they get a bill in the mail months later that they don’t understand. Estimation tools and insurance cards can help ease this uncertainty or to point a practice in the right direction, but ultimately most patients end up in the dark when it comes to what they will owe in the end. 

Patients Want a Better Healthcare Payment Experience


Traditionally, many practices end up providing services for free, collecting a small insurance co-pay, or sometimes not even that, and then opting to bill the patient later, after collecting from insurance first. The problem is the process of settling with and collecting from insurance companies can take days, weeks, or even months and by that time patients are far less likely to pay for bills they receive long after services rendered. In fact, more than 60% of patients surveyed by InstaMed reported they would “consider switching providers for a better healthcare payment experience,” which includes upfront patient responsibility, eligibility, and the ability to pay with their preferred payment methods. 

Real Time Eligibility & Patient Responsibility Estimate Tools Help


With this in mind, it’s hard to believe less than 25% of physician practices have an eligibility and estimation tool in place to assist their practices in maximizing revenue, according to Healthcare Finance News.  By providing real-time patient responsibility estimates, providers can increase patient confidence and are more likely to collect the full amount they are owed for their services. Without an eligibility solution in place, practices could potentially be missing out on between 30-50% of their patient revenue. 

Adapting to The Next Generation of Patients


Speed and transparency make a huge difference when it comes to collecting patient payments. Giving your patients the tools to make the process as simple as possible is key to not only collecting but collecting quickly with high patient satisfaction. Many practices still rely on mailed statements and/or in-person payments, such as cash, check, or credit card, which can be a major hindrance, especially when it comes to younger generations. 

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. Why is this important? Well, the majority of Gen Z have never lived without the internet, smartphones, and immediate access to information and products. With an influx of Gen Z patients, the expectation is that practices make it easy to receive and pay for care. If it’s not, they may seek care elsewhere. 

Make Paying Medical Bills Fast & Easy for Patients


It’s much easier to collect payments when the patient is standing in front of you, but even if they’re not, the quicker a practice requests payment, the more likely patients are to pay it. Recent trends in expected payment options have shown nearly 50% of patients would prefer to pay their medical bills using contactless or paperless payment options. Practices using paper statements introduce significant lag into their collection systems by relying on mail carriers and printing/packing services. Recent improvements in payment processors and the technology they offer have made it possible to send statements and payment requests in real-time to speed up collections and boost patient satisfaction and confidence. 

Everything Should Be in One Place


The last part of the equation is making sure everyone in the practice is on the same page regarding patients’ financial status. The fewer systems involved, the less room for error and inefficiency. From patient intake to collecting payments, it’s important to be able to do everything in one place without having to log into multiple systems to piece together information.

Find Out How pMD Medical Billing & RCM Services Can Help


If you are interested in learning more about pMD’s billing and 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!

 

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.

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* Reduce Claim Denials with Real-Time Eligibility