Category Archives: iMAX Medical Billing Insights

3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency

As providers engage in complex payment models and collect more from patients, they must learn to automate key functions to improve healthcare revenue efficiency. The healthcare revenue cycle has many moving parts. From patient access and registration to medical billing and coding, provider organizations of all sizes must achieve revenue cycle efficiency to ensure providers get paid promptly and accurately. However, achieving revenue cycle efficiency is a major challenge, especially for larger organizations with multiple service locations. Patient financial responsibility, value-based purchasing, healthcare consumerism, and other major trends are also putting pressure on providers to boost revenue cycle efficiency. Providers

The Benefits of a New Revenue Cycle Paradigm

Automating patient experiences, eliminating manual workflows, optimizing for outcomes, and reimagining payment methodologies will bring transformative benefits to the revenue cycle. Technology is enabling patients and providers to connect in an unprecedented manner. The Internet, smartphones, wearables, and other technologies are allowing for instantaneous communication between providers and their patients and more types of data to leverage. While patients are becoming more engaged with their care, healthcare revenue cycles can leverage the newfound connection to realize revenue cycle benefits. Adapting the revenue cycle to the new connected world will be a significant transformation for most provider organizations. Investments in revenue

Freestanding Emergency Departments Cost 22 Times More Than Doctor

A case study of freestanding emergency departments in Texas shows shifting care to doctors and urgent care centers could save $800 million annually. Shifting care from freestanding emergency departments to physician offices and urgent care centers would save over $3,000 per visit, showed a recent brief from the managed care company UnitedHealth Group. The company found that freestanding emergency departments cost significantly more than other lower cost care sites for common, non-emergent conditions. But consumers do not always realize that seeking care at the facilities will result in higher costs. Freestanding emergency departments are hospital-owned or independent facilities that are licensed

NY Group Rethinks Physician Consolidation to Add Long-Term Value

A group practice in New York is centralizing business operations with their peers to keep practices independent in the face of rapid physician consolidation. March 18, 2019 – Physician consolidation, value-based care, and other market pressures are sounding the death knell for many small and independent practices. Less than a third of physicians owned an independent practice in 2018, according to a Physicians Foundation and Merritt Hawkins survey. Instead, almost half of the surveyed physicians said they closed shop and/or started working for a hospital or medical group. Surviving as a small or independent practice in the current healthcare economy is hard. Providers are

NY Hospital Settles with Cerner Over $38M Medical Billing Problem

Glens Falls Hospital and Cerner agreed to settle allegations that the EHR company’s medical billing system malfunctioned and failed to send out bills in 2017. Cerner recently reached a settlement with a New York hospital after an audit revealed the EHR system’s medical billing component resulted in $38 million in financial losses in 2017, a local news source reports. Dianne Shugrue, President and CEO of Glens Falls Hospital announced the settlement with Cerner in a full-page ad in The Post-Star. Shugrue stated in the ad that the billing problem lasted for two years, causing the hospital “financial hardship.” The hospital reduced operating costs and

Being a best-run practice: Why it matters now and in the future

Many physician owners and practice administrators feel overloaded with day-to-day demands. With so many balls in the air, they may find they have very little time (or desire) to invest in the continuous improvement needed to become a best-run practice. It’s relatively easy to see how management effectiveness could improve profitability. But if you’re satisfied with your collections and productivity, and your practice is very busy, are there still good reasons to create an even better-oiled machine? Of course, the answer is yes. Consider the following benefits that best-run practices enjoy: 1. The payoff of a better patient experience. When coupled with

6 leverage points small practices have with payers

It’s commonly believed that small practices are at a disadvantage when it comes to renegotiating contracts with big payers. After all, these payers have the muscle to set the terms of the deal. But that’s not always the case. If you’re small, you may have more leverage than you think. Here are six things you may not have thought of that can increase your pull with payers. If you have them, make sure your payers know.   You keep long hours. For those practices that keep them, extended hours are a huge advantage, especially in primary care. “Having extended hours

How to get out of the office

“Time off? Surely you jest,” wrote C.K. Hebdon, MD, in response to Physicians Practice’s query about going on vacation. Hebdon is the owner and sole physician at the Center Performance & Longevity in Salt Lake City. An addiction medicine specialist, he says there is no other nearby specialist who can cover his clinic when he leaves, so he rarely takes time off from his practice. “And if I take a day off, I’m punished by having to fit in that day’s patient load into the surrounding days,” he notes. “Monthly visits and prescriptions must be maintained.” In Physicians Practice’s 2018 Great American Physician Survey, 29

The dangers of trusting your employees too much

Preventing and addressing dishonesty in the workplace continues to challenge my physician practice clients. Recently, a client suffered an extreme example of how workplace dishonesty can cause harm. Her scary story is unfortunately familiar to many providers out there. The situation began with a visit from a payer’s fraud department. The investigators reviewed patient charts with my client, the practice owner, and hinted at fraudulent billing and other improprieties. She could not understand the investigators’ claims and did not recognize the patient names at issue. She began by looking for the patients’ names in the system. We immediately realized the