Happy Holidaze: Be Sure Your ICD-10 Code Book is Close By
Season’s greetings to all! As we enter the busy holiday season, you are sure to begin seeing an uptick in patient visits.
You may want to be on the lookout for the following ailments:
As you close out the books to a successful, though likely challenging 2016 due to ICD-10, we’d like to offer a
happy holiday greeting to all, and best wishes for a prosperous 2017!
Healthcare Consumerism is Shaping Payer/Provider Relationships
Consumers today have it easier than ever before. In this digital age, information is as accessible as the air we breathe. There are apps that help us compare mortgage loans, the cost of a car, even groceries.
Consumers are savvy and are rightfully seeking pricing information from providers – before a service is performed. It’s only natural.
However, the healthcare industry has some obstacles to overcome to achieve this level of transparency, even with the mandates of the Affordable Care Act (ACA). Let’s sum it up with a few quick facts from Public Agenda’s 2015 Report. Did you know:
- Most Americans are not aware that prices can fluctuate across healthcare providers. 57 percent of insured and 47 percent of uninsured Americans are not aware that physicians might charge different prices for the same services.*
- 67 percent of those with deductibles between $500 and $3,000, and 74 percent with deductibles higher than $3,000 have sought out price information before getting care.
Despite the obstacles, there is hope.
- 82 percent of those who have compared prices across multiple providers say they will do so again in the future.
The demand for medical cost transparency has led to many alternative payment models (like bundled payments), which are proving extremely beneficial. This “82 percent” stat tells us comparative data analytics work and are increasing transparency and collaboration of medical costs like never before.
These types of changes will ultimately help bottom lines across the industry – making it easier for the patient to make wise budget decisions. Over time, providers would see less payment defaults and payers could monitor and further reduce costs.
So, healthcare industry, what can we do to keep up?
Read the article published by AdvanceWeb to learn more.
Fall is Football Madness: Make Sure You’ve Got the Right ICD-10 Code for That
Go…Huskies! Bobcats! Tigers! Or…insert your favorite football team here.
Wherever your allegiance lies, just be sure that when patients begin to flood your lobby with suspicious injuries, conditions or illnesses you’ve got your ICD-10 code book handy to properly treat, code and bill accurately.
Whatever ailments you’re starting to see, many of the above are likely the cause of football – and we’re not talking the friendly game of flag football either.
For additional resources and information, visit our Knowledge Center.
An 8-item Checklist for Picking the Right RCM Partner
As hospitals and health systems transition to alternative payment models, many are seeking outsourced revenue cycle management services.
Numerous provider organizations believe making the change to value-based payments will require a need for tighter clinical and financial integration, which means adding resources dedicated to improving clnical-financial performance, according to a peer60 report.
The report also reveals the amount of potential RCM segments healthcare organizations are seriously considering for outsourcing has grown in the past year. Accounts receivable management and collections, claims and billing, denial management, contract management and eligibility and benefits, coding, audit, transcription and clinical documentation improvement also are now being included in potential RCM segments needing to be outsourced.
Overall, according to Black Book’s 2016 RCM survey, the U.S. market for physician and ambulatory revenue cycle management outsourcing and extended business office services is expected to increase by 42 percent from the fourth quarter of 2016 to the first quarter of 2019.
Click here to read the full article in Becker’s Healthcare.
Questions and Answers to Seek as you Optimize your Revenue Cycle
There are so many questions to ask in the world of healthcare revenue cycle management. Ask the right questions, and you could find some powerful answers.
How is your business performing? Do you have the data and insight you need to know if your business performance is specific to your organization or is it impacted by industry wide trends?
In a market where shifting payment models have a direct impact on your business, your patients and your clients, it is critical to know the root causes of your biggest business issues and how they are impacting your bottom line.
Did you know that you can leverage the power of healthcare analytics to identify these inefficiencies and overlay the power of comparative analytics to truly understand how your business compares to your peers in the market?
Once you identify your greatest challenges and how you compare to your peers, you can more quickly resolve these administrative and revenue cycle inefficiencies, and put into action a plan to improve.
The main question of course is where do you get the data to compare yourself against your peers? How accurate is the data and what do you do with the data when it is sitting in front of you?
It sounds overwhelming. The good news is, it is not. That is where we come in.
When you get to Medtrade 2016, come by the RemitDATA booth #1451 and we will show you just how simple it is to leverage your own data to quickly identify inefficiencies, and see how you compare against your peers at the state and national level.
View a short demo and walk away with a $10 iTunes gift card! And you will be entered for a chance to win a $100 American Express gift card.
Looking forward to seeing you in Atlanta!
Follow the conversation on social media.
ICD-10: The One-Year Mark, and Preparing for End of Grace Period
Happy anniversary! Or perhaps we should say congratulations for making it through the first year of ICD-10.
If your organization reflects what our data is revealing, the past 12 months have likely been relatively uneventful. Taking a look at our data, we are continuing to see a steady decrease in claims processing and payment velocity. Reviewing average processing time from October 2015 through September 2016, we are noting that processing time is down.
And yet, by the time you read this blog, we’ll be well into October, the grace period for getting the correct code will have ended. As you are likely aware, the Centers for Medicare and Medicaid Services (CMS) stated that it will not extend the ICD-10 grace period beyond October 1, announcement released in August. When ICD-10 went live in 2015, CMS said it would not deny claims as long as healthcare providers used codes in the correct “family” related to the treatment. This is now changing.
Claim denials, already one of the largest areas of lost revenue for healthcare organizations, have even greater potential to impact the bottom line as the grace period ends.
In order to minimize the impact, be sure to benchmark your performance and implement a denials management process, to identify any coding discrepancies or process road blocks.
For additional resources and information, visit our Knowledge Center.
Medical Billing – 5 Insurance Eligibility Steps For Every Practice
According to RemitData, two of the top five claim denial reasons for 2013 were insurance-coverage related. Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan in question. Putting a solid insurance verification process in place can reduce these types of denials in your practice, making medical billing practices more efficient and raising your overall bottom line.
Insurance should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Follow these five steps to reduce the chance your billing team deals with constant eligibility-based denials.
Click here to read full article at Revenue XL