Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit"

Transcription

1 Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician Services-Coding & Compliance

2 Understanding RAC The RAC program has already proven to be a financial boon to the Centers for Medicare & Medicaid Services (CMS). Anyone who bills Medicare could face scrutiny. Consider setting aside a reserve for estimated overpayment amounts. Undertake an office self assessment to uncover possible overpayments. Prepare for timely response to record requests

3 Preventing Billing Errors Standardize language in medical charts and coding departments 1. RAC s look for inconsistencies between what the physician documents and what is billed to the payer. 2. Mistakes occur when translating written ICD-9 codes.

4 Preventing Billing Errors Implement an internal audit process 1. Randomly conduct internal audits 2. 3 rd party audit to determine coding accuracy and possible risk areas.

5 Preventing Billing Errors Provide rewards 1. Positive reinforcement over negative reinforcement for physicians and staff that comply with good practices in Clinical documentation Coding Billing

6 Preventing Billing Errors Institute a clinical documentation improvement program 1. Verify that all clinical staff are following the same documentation guidelines. i.e. vitals, medications 2. Internal random audits to verify accuracy

7 Preventing Billing Errors Be ready for RAC auditors 1. Every provider who bills Medicare is subject to a RAC audit. 2. RAC auditors are reimbursed a percentage based on what is identified as billing errors.

8 Preventing Billing Errors Consider EHR 1. Installing a system that will assist with improving medical documentation can help minimize the incidence for billing errors 2. Eliminate the possibility of being subject to penalities 3. Capture missing revenue opportunities 4. Compliance

9 Charge Capture Get Paid For What You Do! 1) Ensure there is a reconciliation process through the practice management system or daily schedule to ensure all office charges have been entered. 1) Use scheduler in practice management system or daily schedule 2) Office charges should be entered daily no lag time! 3) Ensure encounter form is representative of commonly used procedure codes 2) PDA s can be used for daily inpatient charges, if this is not an option print daily census and use as reconciling tool. 1) Inpatient charges should be turned in daily 2) Ensure practice staff have appropriate access for patient demographics, test results, etc. 3) Surgery charges should be reviewed by a certified coder to ensure all services are billed for. 1) Surgery charges should be entered as soon as the dictated operative report is available for coding. 2) Surgery schedule can be put into practice management system to ensure no missing surgery cases!

10 Managing the Revenue Cycle INDICATOR CALCULATION BENCHMARK Days in Accounts Receivable: how many days on average does it take to liquidate a receivable item? 12 months gross charges/365 Primary Care: <50 days Specialty Care< 60 days % of Accounts Receivable >120 days: the older the receivable, the more difficult it is to collect Net Collection Percentage: how much money was collected on the money that could have been collected? Denial Percentage: why are claims not being paid? Total Accounts Receivable/Total Accounts Receivable +120 days Payments/(Charges+ Contractual Adjustments) Total Zero Payments-Denials/Total Payments <20% >95% <7% Bad Debt Total bad debt adjustments (one year)/total charges (one year) <2%

11 Importance of the Front Desk/Check In First Impressions of your office The collection of accurate demographic and insurance information. Registration staff should be well educated with the various insurances your practice participates with. Insurance verification process should be established for your practice.

12 Policies, Procedures and Education of Staff Keeping your staff informed is critical to the AR process Should have established policies and procedures to ensure standardization Have meetings with staff to keep them educated of changes with insurances, processes etc.

13 Charge Capture and Claim Submission Importance of Clean charges Charges should be entered timely (even hospital charges) Scrub charges before they are submitted to the carriers Claims should be sent electronically and daily Clearing House or vendor should provide reports of claims sent and status of claims

14 Accounts Receivable Process How does your staff monitor un-paid claims? When does your staff review un-paid claims? Do you post denials, and how do you track your top denials? Do you have a standard set of monthly reports for the practice? Do you review the reports with your staff and use them as educational tools? Does your current billing system provide the necessary reports to work the AR? Do you monitor staff productivity? Do you have thresholds set for your practice?

15 Information and Reports Turning Data into Information for Improvement Identify Strengths and weaknesses Provide objective, measurable information Establish trends Improve performance

16 Top 5 Reports A/R Reports Unpaid Claims Lag Time Denial Productivity

17 Accounts Receivable Reports Days in AR A/R over 120 days

18 Unpaid Claims Review at days Follow-up with payer

19 Lag Time Submission of claim within hrs. of service Improve cash flow Faster Submission = Faster Payment

20 Denial Denial reason Patient detail

21 Productivity Benchmarks Track trends

22 Checklist for Improving Accounts Receivable What is the 1 st impression of your office Insurance verification Updated Policy & Procedures monthly staff training on updates Staff informed of the A/R process Scrub charges prior to submission Send claims daily Send hospital and/or nursing home claims daily or weekly Review reports from clearing house on denied claims work daily Review monthly reports

23 TOP TEN Most Common Professional Fee Billing Errors Always assigning same level of service Misinterpreted abbreviations No chief complaint listed for each visit Billing of service(s) included in global period Inappropriate or no modifier used No documentation for services billed No signature on documentation Unbundling of procedure services Billing Consult vs. New Patient Visit Invalid codes billed-due to charge ticket not being updated with new/revised codes

24 Frequently Used Modifiers 22 Unusual Procedural Service 53 Discontinued Service 24 Unrelated E/M service during post-op 57 Decision for surgery 25 Separately Identifiable E&M 59 Distinct procedural service same day as a procedure service 26 Professional Component 76 repeat procedures 50 Bilateral Procedure 80 Assistant Surgeon 51 Multiple Procedures 91 Repeat clinical test 52 Reduced Service

25 At the End of the Day, It s Outcomes that Matter! Outcomes for your Practice: Enhanced Revenues Operating Efficiency Stable, Integrated System Ability to Focus on Patient Care Outcomes for your Patients: Increased Accessibility of Practice Recalls and Reminders for Needed Care Evidence-Based

26 Questions?

Revenue Cycle Management: Tips & Tools

Revenue Cycle Management: Tips & Tools Revenue Cycle Management: Tips & Tools 2010 Annual Educational Seminar March 10, 2010 Presented By: Cindy Tipton, Coding & Compliance Director cindy_tipton@med3000.com What is the Revenue Cycle or Life

More information

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices Give Your Revenue Cycle a Boost Techniques to Improve for Your Physician Practices Presented by: Alta Partners, LLC Stan Kasmarcak Susannah Selnick Lacy Sharratt June 8, 2015 2015 Ohio Hospital Association

More information

Days in Accounts Receivable Days in Accounts Receivable Greater Than 120 Days Adjusted Collection Rate Denial Rate Average Reimbursement Rate

Days in Accounts Receivable Days in Accounts Receivable Greater Than 120 Days Adjusted Collection Rate Denial Rate Average Reimbursement Rate 1 Many providers are under the impression they can assess the financial health of their practice by evaluating cash flow only. However, cash flow is just one factor. You don't have to be a finance expert

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Job Description Billing and Coding Associate

Job Description Billing and Coding Associate Practice Name Job Description Billing and Coding Associate Purpose: The job description of Billing and Coding Associate is a written statement that identifies a job title and its related principal duties

More information

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results

More information

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and

More information

Helping Physicians Drive Better Practice Health

Helping Physicians Drive Better Practice Health McKesson Business Performance Services Revenue Cycle Management Services Helping Physicians Drive Better Practice Health McKesson Business Performance Services Our staff of 7,000+ includes 500+ certified

More information

BILLING COMPANY STANDARDS

BILLING COMPANY STANDARDS BILLING COMPANY STANDARDS ASSESSING PRACTICE VALUE OF OUTSOURCING Cost Saving Efficiencies gained Improved collections Compliance Once a decision to out source is made the following due diligence should

More information

Tennessee Primary Care Association: 2014 Annual Leadership Conference

Tennessee Primary Care Association: 2014 Annual Leadership Conference CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference

More information

Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests

Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests Financial Disclosure Teri Thurston does not have any relevant financial relationships with any commercial interests Transitioning to ICD-10 Planning the Journey for Implementation 2 Brief History of ICD-10

More information

HFMA MAP Keys Patient Access Measure:

HFMA MAP Keys Patient Access Measure: HFMA MAP Keys Patient Access Pre-Registration Rate Trending indicator that patient access processes are timely, accurate, and efficient Indicates revenue cycle efficiency and effectiveness N: number of

More information

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer Common Issues in Practice Management Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer cpmresults.com Industry Trends cpmresults.com Patient Responsibility Patients are now responsible

More information

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management Optimized Have you heard about Revenue Cycle Management (RCM)? It is the process of managing the healthcare revenue cycle within your office that typically results in increased

More information

Trusted Partners for. Revenue Cycle Solutions

Trusted Partners for. Revenue Cycle Solutions Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

Practice Management CSRO Fellows Conference February 20, 2016

Practice Management CSRO Fellows Conference February 20, 2016 Practice Management CSRO Fellows Conference February 20, 2016 Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc West Palm Beach, FL Practice Structure Physicians & Administrator

More information

The Economics of Outsourcing Billing, Collections, and Contracting. Tom Chirillo President & CEO HealthCare Business Solutions

The Economics of Outsourcing Billing, Collections, and Contracting. Tom Chirillo President & CEO HealthCare Business Solutions The Economics of Outsourcing Billing, Collections, and Contracting Tom Chirillo President & CEO HealthCare Business Solutions Goals of Today s Presentation Establish how important Billing, Collections,

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

ICD-10 Post Implementation: News from the Front Lines

ICD-10 Post Implementation: News from the Front Lines ICD-10 Post Implementation: News from the Front Lines Presented by: Paula Kleiman, RHIA, CPC, AHIMA ICD-10-CM Trainer CEO/President, Creatively HIM Consulting Services, Inc. Agenda ICD-10 Post Implementation

More information

Revenue Cycle Management Process

Revenue Cycle Management Process OVERVIEW It is important for everyone involved in the billing cycle process to be familiar with how each step of the encounter provides opportunities to assure successful and compliant billing. The purpose

More information

December 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.

December 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm. December 2011 PRACTICE CHECK-UP XYZ Anesthesia Group AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.com (908)-279-8120 AdvantEdge Healthcare Solutions Anesthesia Practice Check-Up I. Introduction:

More information

Seven revenue-driving best practices

Seven revenue-driving best practices NextGen Revenue Cycle Management Seven revenue-driving best practices 1 2 3 4 5 6 7 Self-pay Collections Measuring Performance Claims Scrubbing Track and Prevent Denials Create and Enforce Write-off Policy

More information

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com Robin Bradbury 800-355-0410 robin@ereso.com Top Ten Questions 1. What are the key measures for the Revenue Cycle? 2. How do you document and share this information with the Revenue Cycle staff? 3. What

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC

REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT WHAT S THE BIG DEAL? Productivity = Efficiency + Effectiveness How much input (cost) is needed

More information

New York University School of Medicine Faculty Group Practice Billing and Collection Policies

New York University School of Medicine Faculty Group Practice Billing and Collection Policies New York University School of Medicine Faculty Group Practice Billing and Collection Policies General Policy Statement New York University School of Medicine Faculty Group Practice (NYUSM- FGP) oversees

More information

Office Managers Association at Presbyterian Hospital of Plano

Office Managers Association at Presbyterian Hospital of Plano Office Managers Association at Presbyterian Hospital of Plano Update your charge slips annually Team approach Pain management example Grace period discontinued! New CPT, HCPCS and ICD-9 codes Changed definitions

More information

WHY OUTSOURCE YOUR MEDICAL BILLING? What Are There Real & Tangible Benefits?

WHY OUTSOURCE YOUR MEDICAL BILLING? What Are There Real & Tangible Benefits? WHY OUTSOURCE YOUR MEDICAL BILLING? What Are There Real & Tangible Benefits? Why outsourcing your medical billing can bring you peace of mind and increased prosperity? A sk any healthcare provider practicing

More information

7 Ways to Enhance Your Radiology Group's Revenue Cycle

7 Ways to Enhance Your Radiology Group's Revenue Cycle 7 Ways to Enhance Your Radiology Group's Revenue Cycle Introduction Every radiologist would prefer to be reading charts than spend time thinking about their practice s revenue cycle management processes.

More information

5 MUST-TRACK METRICS FOR PRACTICE PROFITABILITY

5 MUST-TRACK METRICS FOR PRACTICE PROFITABILITY The late, legendary management expert Peter Drucker once famously said, If you can t measure it, you can t manage it. In today s challenging and rapidly evolving healthcare landscape, measurement is more

More information

Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603

Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603 Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603 Phone: (541) 882-1487 or 1-800-552-6290 H.R. Fax: (541) 273-4564 OPEN: 05/08/2013 CLOSED: 05/24/2013 POSITION: RESPONSIBLE

More information

University Healthcare Administrative Policy

University Healthcare Administrative Policy Page 1 of 6 APPROVED BY: Signatures on File FINANCIAL POLICY (UH) is a not-for profit teaching hospital committed to providing quality health care services. In order to provide necessary medical services

More information

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Revenue Cycle Management A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Discussion Overview The Revenue Cycle demystified: How do appointments turn

More information

University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement

University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement June 18, 2013 Mari Anne Ehler Associate Director, Patient Financial Services UI Health Care Cindy Lowe-Johnson

More information

CHAPTER 17 CREDIT AND COLLECTION

CHAPTER 17 CREDIT AND COLLECTION CHAPTER 17 CREDIT AND COLLECTION 17101. Credit and Collection Section 17102. Purpose 17103. Policy 17104. Procedures NOTE: Rule making authority cited for the formulation of regulations for the Credit

More information

THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse

THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse TRUE OR FALSE: One coding audit a year of a random sample of 30 charts per coder is sufficient

More information

Practice Name. Job Description Billing, Insurance and Coding Specialist

Practice Name. Job Description Billing, Insurance and Coding Specialist Practice Name Job Description Billing, Insurance and Coding Specialist Purpose: The job description of Billing, Insurance and Coding Associate is a written statement that identifies a job title and its

More information

FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments

FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments Long Term Post-Acute Care Providers I am a physician or nurse practitioner

More information

Understanding Revenue Cycle Strategy How to Optimize Process and Performance

Understanding Revenue Cycle Strategy How to Optimize Process and Performance Understanding Revenue Cycle Strategy How to Optimize Process and Performance White Paper 1.800.4BEACON BeaconPartners.com BOSTON CLEVELAND SAN FRANCISCO TORONTO The revenue cycle can no longer be seen

More information

Personalized Specialized Right Sized

Personalized Specialized Right Sized T h e C O R E P r o d u c t o f M e d i c a l B i l l i n g i s K n o w l e d g e Personalized Specialized Right Sized CORE Medical Billing is a privately held company located in High Point, North Carolina

More information

Our clients count on us, and we deliver.

Our clients count on us, and we deliver. Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue

More information

Medicare and Medicaid Programs; EHR Incentive Programs

Medicare and Medicaid Programs; EHR Incentive Programs Medicare and Medicaid Programs; EHR Incentive Programs Background The American Recovery and Reinvestment Act of 2009 establishes incentive payments under the Medicare and Medicaid programs for certain

More information

ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard

ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ICD-10 Lisa Kozakoff Principal Consultant Siemens Healthcare Lisa Kozakoff Principal Consultant Agenda Introduction

More information

Business Service and Process Outsourcing. Metropolitan Business Solutions

Business Service and Process Outsourcing. Metropolitan Business Solutions MBS Business Service and Process Outsourcing Who We Are! A provider of business service and process outsourcing committed to enhancing our clients profitability reducing the cost of business operations

More information

ICD-10 FAQs for Doctors

ICD-10 FAQs for Doctors ICD-10 FAQs for Doctors What is ICD-10? ICD-10 is the 10 th revision of the International Classification of Diseases (ICD), used by health care systems to report diagnoses and procedures for purposes of

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management Manage and Improve Your Results with Origin RCM Financial pressures are escalating for both healthcare providers and patients. In this challenging climate, a wellmanaged revenue

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management ~Becoming a patient focused but metrics driven Revenue Cycle team~ Presented by: Kimberly Moore Director, Health Care Revenue Cycle Consulting 701.239.8673 kmoore@eidebailly.com

More information

ICD-10-CM TRANSITION WORKBOOK

ICD-10-CM TRANSITION WORKBOOK ICD-10-CM TRANSITION WORKBOOK The Next Generation of Coding Preparation is the key to success when transitioning your practice from ICD-9 to ICD-10. The federally mandated compliance date is October 1,

More information

Hospital Denials Management In-source, Outsource or Both?

Hospital Denials Management In-source, Outsource or Both? Page 1 Hospital Denials Management In-source, Outsource or Both? by Holly Pelaia Summary A strong revenue stream case is made for intelligent outsourcing of hospital denials up to 20% more effective in

More information

REVENUE CYCLE MANAGEMENT : A DEEPER DIVE

REVENUE CYCLE MANAGEMENT : A DEEPER DIVE REVENUE CYCLE MANAGEMENT : A DEEPER DIVE 2016 TABLE OF CONTENTS Introduction The Participants Revenue Cycle Steering Committee Personnel Accounting Platform Service Outsourcing Performance Metrics Accounts

More information

Medical Documentation Barry H. Block, DPM, JD bblock@podiatrym.com

Medical Documentation Barry H. Block, DPM, JD bblock@podiatrym.com Medical Documentation Barry H. Block, DPM, JD bblock@podiatrym.com 1 Why is Documentation Important? Why is Documentation Important? Reimbursement 2 EMR DOCUMENTATION ABSURD ICD 10 CODE V97.33XD: Sucked

More information

Revenue Cycle Management Optimized

Revenue Cycle Management Optimized rreturnsttopbooth2014final.indd 1 6/13/2014 9:32:34 AM Revenue Cycle Management Optimized Powerful technology combined with expert knowledge and resources Innovative Revenue Cycle Management brought to

More information

Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services

Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services Introduction to ICD-10: A Guide for Providers Centers for Medicare & Medicaid Services 1 Table of Contents Compliance Date: October 1, 2014» What is ICD-10?» Why ICD-10 matters» Why transition to ICD-10»

More information

6/6/2012. Best Practices to Improve Billing and Collections. Overview. On the Front End. Lisa Rock, President National Medical Billing Services

6/6/2012. Best Practices to Improve Billing and Collections. Overview. On the Front End. Lisa Rock, President National Medical Billing Services Best Practices to Improve Billing and Collections Lisa Rock, President National Medical Billing Services June 15, 2012 10 th Annual Orthopedic, Spine and Pain Management Driven ASC Conference: Improving

More information

Teamwork Leads to Getting Claims Paid

Teamwork Leads to Getting Claims Paid Teamwork Leads to Getting Claims Paid Linda R Georgian, COE Administrator Inland Eye Institute Medical Group, Inc. Financial Disclosure Both presenters acknowledges a financial interest in the subject

More information

Revenue Cycle Management Excellence Easily improving bottom line!!!!!

Revenue Cycle Management Excellence Easily improving bottom line!!!!! Revenue Cycle Management Excellence Easily improving bottom line!!!!! SN Academy Seminar 9 th May 2014 PRR 5/5/14 Revenue Cycle Management ; Are you doing it right? Are you earning what you deserve? Do

More information

BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP?

BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP? CPAs & ADVISORS experience direction // BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP? OHIO ASSOCIATION OF COMMUNITY HEALTH CENTERS ~ 2014 ANNUAL CONFERENCE Wednesday, March 12, 2014

More information

Chiropractic Billing

Chiropractic Billing Chiropractic Billing How To Gain A Competitive Advantage In This Challenging Reimbursement Environment Welcome to CloudChiro! We ve been working with over 500 chiropractic offices over the years, and we

More information

Pain-Free Managed Medical Billing

Pain-Free Managed Medical Billing Pain-Free Managed Medical Billing Focus on Patients, Not Billing www.drchrono.com Pain-Free Billing Medical Billing is a major component of every medical practice; in this age of reduced reimbursements,

More information

12 16 Memorial Physician Network Billing Cycle Audit Report

12 16 Memorial Physician Network Billing Cycle Audit Report O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12 16 Memorial Physician Network Billing Cycle Audit Report September 2012 O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12

More information

Midwest Orthopaedic Center. Orthopaedic. EHR Case Study. Midwest Orthopaedic Streamlines Revenue Cycle with Integrated Suite of Pulse Solutions

Midwest Orthopaedic Center. Orthopaedic. EHR Case Study. Midwest Orthopaedic Streamlines Revenue Cycle with Integrated Suite of Pulse Solutions EHR Case Study Orthopaedic Midwest Orthopaedic Center Midwest Orthopaedic Streamlines Revenue Cycle with Integrated Suite of Pulse Solutions pulseinc.com Pulse Complete EHR 13 board-certified physicians.

More information

Meaningful Use Rules Proposed for Electronic Health Record Incentives Under HITECH Act By: Cherilyn G. Murer, JD, CRA

Meaningful Use Rules Proposed for Electronic Health Record Incentives Under HITECH Act By: Cherilyn G. Murer, JD, CRA Meaningful Use Rules Proposed for Electronic Health Record Incentives Under HITECH Act By: Cherilyn G. Murer, JD, CRA Introduction On December 30, 2009, The Centers for Medicare & Medicaid Services (CMS)

More information

Importance of Auditing

Importance of Auditing Medicare 201: Practitioner Importance of Auditing EY Fraud Investigation and Dispute Services Jennifer Shimek, Senior Manager Gretchen Segado, Manager Agenda Importance of Auditing National and Local Coding

More information

Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc.

Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. Reasonable efforts have been made to provide the most accurate and current information on CPT 2015 code changes. However codes,

More information

Glossary of Frequently Used Billing and Coding Terms

Glossary of Frequently Used Billing and Coding Terms Glossary of Frequently Used Billing and Coding Terms Accountable Care Organization (ACO) Accounts Receivable Reports All Inclusive Fees Allowances and Adjustments Capitation Payments Care Coordination

More information

Caryl A. Serbin President and Founder Serbin Surgery Center Billing, LLC and. Becky Ziegler-Otis

Caryl A. Serbin President and Founder Serbin Surgery Center Billing, LLC and. Becky Ziegler-Otis 1 Presented by Caryl A. Serbin President and Founder Serbin Surgery Center Billing, LLC and Becky Ziegler-Otis Administrator Ambulatory Surgical Center of Stevens Point 2 ASC STEVENS POINT Days in A/R

More information

SECTION 4. A. Balance Billing Policies. B. Claim Form

SECTION 4. A. Balance Billing Policies. B. Claim Form SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing

More information

Granville Health System

Granville Health System Approved by: Granville Health System FINANCIAL POLICY Effective Date: Revised Date(s): FINANCIAL POLICY - DRAFT 09-16-2014 Granville Health System is a not-for profit hospital committed to providing quality

More information

Financial Accounting and Management Reports

Financial Accounting and Management Reports Financial Accounting and Management Reports To manage a medical practice effectively, whether it be a solo or a group practice, the practitioner and its managers and advisors must have continual access

More information

AR MANAGEMENT FOR THE LTC PROFESSIONAL

AR MANAGEMENT FOR THE LTC PROFESSIONAL 1 AR MANAGEMENT FOR THE LTC PROFESSIONAL LEADINGAGE MICHIGAN 2015 LEADERSHIP INSTITUTE Carolyn Lookabill Notice of Disclosure 2 Richter Healthcare Consultants has produced this material as an informational

More information

OBJECTIVES. Session 115 How to Manage Accounts Receivable & Cash Flow. M. Aaron Little, CPA. Melinda A. Gaboury, COS-C.

OBJECTIVES. Session 115 How to Manage Accounts Receivable & Cash Flow. M. Aaron Little, CPA. Melinda A. Gaboury, COS-C. Session 115 How to Manage Accounts Receivable & Cash Flow Melinda A. Gaboury, COS-C Healthcare CPAs Provider & ADVISORS Solutions, Inc. Chief Executive Officer mgaboury@healthcareprovidersolutions.com

More information

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date:

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date: Approved by: Page: 1 SCOPE: This policy applies to USMD Hospitals. PURPOSE: USMD Hospitals will provide charity care to patients who incur a significant financial burden as a result of receiving medically

More information

The Power of Revenue Management

The Power of Revenue Management The Power of Revenue Management Presented By Judy Capko Capko & Company www.capko.com The Power of Revenue Management 6/13/07 1 About the Speaker The Power of Revenue Management 6/13/07 2 The Speaker:

More information

SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION

SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION 1 SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION MICHAEL BRENNAN SENIOR MANAGER CAROLINE RADER ZNANIEC EXPERIENCED MANAGER AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois www.ahia.org

More information

EHR s-new Opportunities for the Confident Coder

EHR s-new Opportunities for the Confident Coder EHR s-new Opportunities for the Confident Coder Angela Jordan, CPC Chair AAPCCA Board of Directors Manager Coding and Compliance EvolveMD amjordan.cpc@gmail.com Objective EHR basics Basic knowledge of

More information

Health Care. Revenue Cycle Management Services. www.strategic-medical-management.com

Health Care. Revenue Cycle Management Services. www.strategic-medical-management.com Health Care Revenue Cycle Management Services We are Strategic Medical Management Inc. is a technology and process driven organization, serving physicians in the hospital, nursing home and office setting

More information

Selecting a Billing Service. What to Look for When Selecting a Billing Service

Selecting a Billing Service. What to Look for When Selecting a Billing Service Selecting a Billing Service What to Look for When Selecting a Billing Service Overview 1 The best medical billing services do far more than just process claims. They follow up with insurance companies,

More information

MANAGEMENT LETTER. Nassau Health Care Corporation and Subsidiaries Year Ended December 31, 2013. Ernst & Young LLP

MANAGEMENT LETTER. Nassau Health Care Corporation and Subsidiaries Year Ended December 31, 2013. Ernst & Young LLP MANAGEMENT LETTER Nassau Health Care Corporation and Subsidiaries Year Ended December 31, 2013 Ernst & Young LLP Ernst & Young LLP 5 Times Square New York, NY 10036-6530 Tel: +1 212 773 3000 Fax: +1 212

More information

5/16/2014. Revenue Cycle Impact Documentation risks in an EMR AGENDA. EMR Challenges Related to Billing and Revenue Cycle

5/16/2014. Revenue Cycle Impact Documentation risks in an EMR AGENDA. EMR Challenges Related to Billing and Revenue Cycle EMR Challenges Related to Billing and Revenue Cycle Lori Laubach, Principal Health Care Consulting California Primary Care Association Billing Managers Peer Conference May 20 21, 2014 1 The material appearing

More information

The EHR Incentive Program

The EHR Incentive Program The EHR Incentive Program Summary of the Centers for Medicare and Medicaid Services (CMS) Final Rule on Meaningful Use On July 13th, the Centers for Medicare and Medicaid Services (CMS) released its final

More information

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015 Revenue Cycle Best Practices to Increase Collections, Reduce A/R and Increase Patient Satisfaction Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23,

More information

Case. Study. For more information contact Kirk Reinitz email: kirk.reinitz@radadvocate.com tel: 614-761-8334.

Case. Study. For more information contact Kirk Reinitz email: kirk.reinitz@radadvocate.com tel: 614-761-8334. 41 Introduction Many radiology practices operate like Radiological Physicians Associates, Inc. (RPA) of Fairmont West Virginia used to operate. Like most radiology practices RPA depends on their coding,

More information

our group Mission Overview Offering

our group Mission Overview Offering ABOUT OUR COMPANY Mission Infrahealth is dedicated to offering cost-effective infrastructure solutions tailored to achieve maximum results for healthcare professionals. We are focused on delivering medical

More information

POST ACA REVENUE CYCLE TRANSFORMATION

POST ACA REVENUE CYCLE TRANSFORMATION POST ACA REVENUE CYCLE TRANSFORMATION Agenda Intro Revenue cycle features ACA impact areas What did we expect? UDS and PMG data analytics Top to-do items Summary WWW.GOPMG.COM ICD 10 Update* Encounters

More information

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected

More information

Common Medicare Billing Mistakes Systems and protocols necessary to help prevent and overpayment Best practices in resolving an overpayment

Common Medicare Billing Mistakes Systems and protocols necessary to help prevent and overpayment Best practices in resolving an overpayment Bill J. Ulrich, President / CEO Consolidated Billing Services Inc. Pat Newberry, Director of Clinical Education AIS Inc. Common Medicare Billing Mistakes Systems and protocols necessary to help prevent

More information

Adopting an EHR & Meaningful Use

Adopting an EHR & Meaningful Use Adopting an EHR & Meaningful Use Learn how to qualify for the EHR Incentive Program The materials in this presentation, or prepared as part of this presentation, are provided for informational purposes

More information

9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money?

9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money? Coding Compliance for the IDS Environment Could Your Coding be Costing You Money? Nancy Enos, FACMPE, CPC-I, CPMA, CEMC MGMA 2015 Annual Conference Learning objectives 1. Discover how administrators of

More information

Shorten the Revenue Cycle with Electronic Charge Capture

Shorten the Revenue Cycle with Electronic Charge Capture Shorten the Revenue Cycle with Electronic Charge Capture Presenters Ryan Secan, MD MPH Anthony Wehbe, DO, MBA, FACOI Ryan Secan, MD MPH About the Presenters Practicing Hospitalist, Emerson Hospital, Concord

More information

Learn to understand aged AR Learn to work AR. Learn to manage AR. Get the old stuff paid. Where do we go from here?

Learn to understand aged AR Learn to work AR. Learn to manage AR. Get the old stuff paid. Where do we go from here? Learn to understand aged AR Learn to work AR Get the old stuff paid Learn to manage AR Where do we go from here? Accounts Receivable are unpaid payments/charges that are owed to you by the patients and/or

More information

The RN-Coder Network 1142 S. Diamond Bar Blvd. Suite 796 Diamond Bar, CA 91765 www.rn-coder.com www.rn-auditor.com www.rncodericd10.com 909.579.

The RN-Coder Network 1142 S. Diamond Bar Blvd. Suite 796 Diamond Bar, CA 91765 www.rn-coder.com www.rn-auditor.com www.rncodericd10.com 909.579. Services Overview The RN-Coder Network is pleased to offer a variety of health information management (HIM) and medical coding solutions for healthcare facilities throughout the country. RN-CODER will

More information

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,

More information

Our Billers Collect More & Faster

Our Billers Collect More & Faster Our Billers Collect More & Faster advancedbiller ADP ADVANCEDMD PARTNER PROGRAM we are experts experienced your medical billing solution Diversified Reimbursement Systems, Inc. WHO WE ARE Diversified Reimbursement

More information

Using Six Sigma Concepts to Improve Revenue Cycle

Using Six Sigma Concepts to Improve Revenue Cycle Using Six Sigma Concepts to Improve Revenue Cycle Presented by Joseph Koons, MHSA, FHFMA, CRCE-I Managing Director, Revenue Cycle Centra Health Lynchburg Virginia March 4, 2014 Agenda Introduction to

More information

HCCA COMPLIANCE INSTITUTE. HCCA - AHIA Auditing & Monitoring Focus Group Progress Report

HCCA COMPLIANCE INSTITUTE. HCCA - AHIA Auditing & Monitoring Focus Group Progress Report HCCA COMPLIANCE INSTITUTE New Orleans, LA Tuesday, April 19, 2005 Workshop from 3:00pm 4:00pm HCCA - AHIA Auditing & Monitoring Focus Group Progress Report Randall Brown, CIA Baylor Healthcare System Corporate

More information

Re: Medicare and Medicaid Programs Electronic Health Record Incentive Program Stage 2

Re: Medicare and Medicaid Programs Electronic Health Record Incentive Program Stage 2 May 7, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-0044-P Mail Stop C4-26-05 7500 Security Boulevard

More information

The Role of the Recovery Audit Contractor

The Role of the Recovery Audit Contractor The Role of the Recovery Audit Contractor Presented by: Franco Signor LLC Brought to you by: Alliance Collection Services, Inc. 6404 Manatee Avenue West, Suite N, Bradenton FL 34209 / 888-959-0692 / www.francosignor.com

More information

Using Computer Assisted Audit Techniques For More Effective Compliance Auditing and Monitoring In Healthcare Organizations

Using Computer Assisted Audit Techniques For More Effective Compliance Auditing and Monitoring In Healthcare Organizations Using Computer Assisted Audit Techniques For More Effective Compliance Auditing and Monitoring In Healthcare Organizations Author: Glen C. Mueller, Chief Audit & Compliance Officer, Scripps Health, San

More information