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.

POSTS BY TAG | Billing Service

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.

 

At the time of writing this blog, Valentine's Day was right around the corner. Love was in the air, teddy bears and chocolates had blossomed all over my Amazon Prime homepage, and a flurry of statistics and fun facts about the holiday had hit my news feed:

*9 million proposals were expected to be made on Valentine's day 
*1 million people were expected to change their relationship status on social media

That’s a lot of commitment!

Recently, at pMD, I’ve been working with physician practices on another area of commitment: who to entrust with their revenue cycle. Health care practitioners rely on their billing teams to send out health insurance claims and patient statements to keep their practices functioning. Practices are heavily dependent on the effectiveness of their revenue cycle to keep their doors open and to track their financial health. When looking at an existing or potential partnership with a billing team, how do you know if it’s the forever commitment or if it’s time to re-evaluate?

Will U B Mine?

Choosing the right billing team can feel a lot like speed dating with potential billing companies, certified coders, and billing specialist candidates. Thirty minutes to an hour-long conversation with multiple candidates to determine if this is the right long-term fit for your group is a huge investment of time but at the same time doesn’t seem like enough. However, most groups are hard-pressed to make a decision quickly for fear that accounts receivable will just back up and incomes halt to a dead stop. When there is urgency and a need, it can be tricky to sort through exactly what you are looking for. At the end of the day, they will all get your insurance claims out the door, right? 

There are three key elements that you can use to evaluate to see if your current or future billing service is the one for you. 

Trust

Do you trust this billing team? Making sure you have communication flowing both ways is key. pMD is built on a passion for communication and that remains a foundational item for us in revenue cycle management. Clear communication helps practices by keeping clinical and administrative teams on the same page with updates, changes, and opportunities for improvement. 

Another element to look for is expertise in the industry, and I don’t just mean the amount of time spent in billing. Health care practices come in all shapes and sizes. There are specialty-specific and regional considerations when it comes to billing claims. Having a partner that understands the intricacies of your practice from the revenue side as well as the clinical side will allow for trust and ultimately help your practice grow. 

Transparency

Do you know where you stand financially? As a practice owner, there shouldn’t be a challenge in getting a report for your data. Knowing where your business is financially is critical to making sure you are hitting the benchmarks and goals you have planned for. Are you able to see where the inefficiencies are in your revenue cycle? Identifying the source of creeping charge lag, the root cause of an increase of a specific denial, or even trends in payment amounts is the first step to set your practice up with a plan to correct it. 

Partnership

Can you count on your billing team to support your goals? Medical billing has a ton of data flowing through the system and your billing team is the closest to that information. Their insight can help identify and propose solutions to address items that are holding you back from your full potential. These are the specialists that can help educate your team on best practices or provide background information on why different elements are important to claims. Your billing service is the team supporting you and your practice and is the one you need to be invested in your success. 

At pMD, we want to see you succeed! Let’s chat more about our billing service offerings and what we can do to help you.


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