Category Archives: iMAX Medical Billing Insights

Spotlight: Services Excluded from Global Surgery Payment

The following services are excluded from global surgery payment according to Noridian Medicare.  These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial evaluation is always included in the allowance for a minor surgical procedure; Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record;

Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

Question I submitted a claim to the VA and it’s being denied. Why? Answer There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic care. Although the VA has expanded care options for veterans, like all payers, they do have policies that need to be followed. Unless you are contracted directly with the VA, you are most likely billing through their Patient-Centered Community Care Program (PC3) or the Veterans Choice Program

An active shooter in physician offices: Planning for the unthinkable

Safety, Difficult Patients, Managers Administrators, Older Patients, Patient Relations, Risk Assessment, Risk Management, Training An active shooter or an armed intruder at a medical practice office is unthinkable, but it has happened. Every healthcare provider has to accept the reality and realize it can happen anywhere, including at your practice. It doesn’t matter how well you think you know your patients, their families, your staff, or anyone else. There are hundreds of documented cases where the victims shared a common thought afterward: “I’d have never dreamed he/she would do something like that.” Therefore, it is imperative that medical practices everywhere, of all specialties and sizes, prepare for

Position your newly hired clinician for success

Whether you’re hiring a physician or a non-physician provider, odds are you’ll spend a great deal of time (and probably money, too) attracting the right clinician candidate to your practice. If that new hire ultimately doesn’t work out, your practice will face the costs of going back to square one—as well as lost revenue while that job remains unfilled. Effective onboarding can help ensure your new hire knows what is expected and become productive more quickly. Yet despite the high stakes involved, getting new hires off to a good start often gets much less attention than recruiting does. Protect that

Private practice and professional satisfaction

A recent study published in Medical Care Research and Review found that hospital systems that employ physicians perform worse on certain quality measures than those who contract with physicians. In fact, patient satisfaction was actually lower when physicians were employed. This is probably no surprise to independent doctors. It’s not that independent doctors work harder—they work differently. The incentives and motivations are different when you have your own practice, with your name on the door and personal relationships with your patients. The business model of employing physicians at large systems had good intentions—it was meant to improve the continuity of care and

Allscripts EHR System Acquisition Receives Grand Jury Subpoena

Practice Fusion, the EHR vendor acquired by Allscripts last year, has received a grand jury subpoena as part of a criminal investigation. Allscripts recently revealed its EHR system offering acquired through Practice Fusion is the subject of a grand jury subpoena, according to an Allscripts Securities and Exchange Commission (SEC) filing released May 3. The criminal investigation centers on how Practice Fusion obtained health IT certification. Allscripts officially acquired Practice Fusion on February 13, 2018 in a $100 million cash deal. Practice Fusion’s EHR technology complements Allscripts existing ambulatory clinical portfolio as a value offering to accommodate under-served clinicians in small and

Physician Perspectives: Raksha Joshi

I decided I wanted to be an obstetrician and gynecologist (OB-GYN) when I was around 5 years old. My father often recalled the day I made the announcement, “I am going to be a doctor, and I am going to be a doctor specially for women.” It was around that time that my mother was taken ill. No one could figure out what was wrong with her except that it was a quote unquote woman’s problem. She was eventually diagnosed and successfully treated over a period of time. During her treatment, my determination to become a women’s health specialist became

Breaking Free: More Docs Go Independent

Save time and money and gain happiness like these doctors It may not be skydiving, but the top item on the “bucket list” of Terry Edwards, MD, is a bold leap in an age of ever larger healthcare conglomerates. This spring, Edwards will launch his own primary care practice in Bozeman, an upscale college and ski town in Montana. A partner in a practice that sold to a local hospital system back in the early 2000s, Edwards grew disenchanted over time. One of the last straws came when the hospital made changes to a non-compete agreement to bar him and

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