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.

POSTS BY TAG | RCM


 

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.


I’ve worked in health care for many years, and while providers face their fair share of challenges, there’s one question that I’ve noticed almost always bubbles to the top - who do I ask about coding questions? This can be especially distracting as they attempt to focus their efforts on providing the best medical care.

Why Coding is So Difficult

Coding appears to be a thorn in everyone’s side. Why is that? Well, imagine having to enter codes on patients 30+ times a day! Currently, to determine whether you’ve made the correct E&M (evaluation and management) code selection, providers must successfully meet each criterion of the 1997 Documentation Guidelines for E&M Services. Yes, you read that correctly, 1997! 

Let’s take a look at charge code 99213 as an example. While this may seem like a straight-forward, low-level subsequent visit, think again! To correctly select this code, you need to meet two of the following three requirements: 1) an expanded problem-focused history; 2) an expanded problem-focused examination; and/or 3) medical decision-making of low complexity. But, that’s not all. Now answer the following question; how do you define and determine expanded and low complexity? Each of the previously required components is broken down even further into several categories and elements that need to be considered.

As you can see there are many variables that go into selecting the correct code. The question many providers are left with is: who has time to reference the various guides and available resources when trying to complete a patient visit? Unfortunately, inaccurate coding can lead to significant penalties and lost revenue.

The Consequences of Medical Coding Errors

The good news is that changes are coming. Starting in 2021, time-based billing will be available for applicable services, dramatically reducing the complexity associated with code selection. CMS alone has reported a 9.2% monetary loss due to incorrect coding and 55.2% loss due to insufficient documentation in the CY of 2019. If you were to submit an incorrect claim to the government, this would violate the Federal Civil False Claims Act (FCA). Penalties may include substantial fines and even possible imprisonment. As frightening as those repercussions are, the most common consequence of medical coding errors is not receiving reimbursement from the insurance carriers. 

It’s about time we actually apply the infamous motto “patients over paperwork” and remove the providers’ burden of having to recite coding guidelines. Thus, eliminating the fear of possible sanctions due to inaccurate coding.

pMD Helps Solve Coding Problems & Meet Medical Billing Needs

At pMD, we can create customized edits designed to prompt providers to select accurate codes based on specific parameters and requirements, such as charge code or diagnosis criteria, NCCI edits, patient demographics, and much more. This is a quick, seamless process that enables the provider and biller to feel confident in their code selection. Just a few extra clicks based on prompts can assist with accurate and timely claims submission. Additionally, it can result in quicker payment turnaround as well as the appropriate utilization of E&M codes. 

pMD is continuously evolving to serve the medical billing needs of practices. Contact us to learn more about how pMD can best assist you and your practice!

Related Articles:
Standardized Code Sets, Their Impact on Providers & the Solutions
Investing in Partnerships Pays Dividends
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 registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.



It seems you’ve made your way to pMD's blog and want to know more about what charge capture really is. This blog is your guide. You've heard the buzzword all over health care, so let's begin by answering the question, “What is charge capture?”

SO WHAT EXACTLY IS CHARGE CAPTURE?

Charge capture is a process used by doctors and other health care providers to get paid for their services. In its simplest form, charge capture is the process whereby doctors record information on their services, which is then sent out to different payers and insurance companies for reimbursement. For example, let’s say a doctor sees you in the hospital, and after 30 minutes of care, the doctor diagnoses you with hypertension. Both the hypertension diagnosis and the 30 minutes of care translate into separate codes which are eventually submitted for reimbursement.

HOW ARE CHARGES CAPTURED?

One of the big variables in charge capture among medical practices is the way in which doctors record and transfer this information back to their offices and billing staff.

Pop Quiz: What are doctors using to capture their charges?

A) Smartphones
B) Post-it notes
C) Spreadsheets
D) Cafeteria napkins
E) All of the above

The correct answer? E. There are numerous ways to capture charges, and as you may have guessed, some methods are certainly more effective than others.

WHY USE MOBILE CHARGE CAPTURE?

As an alternative to paper-based systems like index cards, hospital print-outs, or cafeteria napkins, electronic charge capture ensures faster reporting and greater billing accuracy. When doctors submit charges electronically, it also reduces data entry errors along the way and eliminates the need to decipher enigmatic handwriting. And when you’re busy caring for patients, who really has time to memorize thousands of diagnosis and charge codes? Plus, paper can't keep up with ever-changing government regulations such as MIPS, but electronic charge capture can incorporate many solutions right into the software to make things as easy as possible.

The best and most efficient form of charge capture involves using mobile devices, such as smartphones or tablets. Doctors can record their charges using a charge capture application on their phones, allowing them to enter charges on the go. With advanced code search functionality, it’s unbelievably fast and easy, giving providers a convenient way to select customized diagnosis codes during the charge capture process. And because they can submit these electronically, doctors no longer have to shuttle paper charges back and forth from the hospital to their office. In essence, it extends the practice to the hospital and the hospital back to the practice, so providers can stay on top of everything in real-time.

WHAT ABOUT SECURITY?

Mobile charge capture is also the most secure method because all of the data is encrypted, both on the device and in transit. This way, doctors don’t have to worry about misplacing a paper charge and putting confidential patient information at risk.

CHARGES ARE SUBMITTED, WHAT’S NEXT?

Capturing charges is one thing, but what comes next? Don’t worry, we’ve got you covered here as well! The next step is billing and collections, or to put it simply, getting paid. Another big benefit of capturing charges in pMD, is the ability to then bill for those charges without needing to use another software vendor and/or service. pMD streamlines the entire practice from point-of-care through reimbursement. With customizable prompts and easy, accurate code selection on the front-end, combined with claim scrubbing, transparency and reporting on the back-end; providers can take care of their patients, while our team of revenue cycle experts will take care of the medical billing and collections. It can be that easy! 

pMD provides intuitive, elegant mobile charge capture software that improves patient care and makes doctors happy. Learn more about pMD charge capture.

 

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.