Category Archives: iMAX Medical Billing Insights

Four reasons to integrate EHR and practice management software

You have EHR software, and you have practice management software. But they aren’t on speaking terms. They don’t even speak the same language, and this language barrier may be doing more harm to your practice than you realize. Simply integrating these two systems can fix a lot of problems. If you’ve been hesitating to take the plunge, here are a few reasons why you shouldn’t wait. You’ll save time “Integrating medical records and practice management software cuts out a lot of duplicate effort,” says Laurie Morgan, a San Francisco-based senior consultant and partner with medical consulting firm Capko & Morgan.

A Poor Medical Billing Process Can Impact Patients

June of last year, we started reviewing every single statement prior to sending it out to the patient. We have pulled about 25 percent of those statements each month due to the patient payment and statement crossing in the mail; an incorrect patient cost-share implemented by the payer; coding or payment posting inconsistencies; or EHR issues. By pulling these statements, fixing any issues, and then re-running the statement, we have increased our customer satisfaction rate 10-fold. This was and still is the single greatest system that we implemented into our billing process. If you have all of your claims clean

3 financial metrics to drive better practice performance

“You can’t manage what you don’t measure.” This is so true in so many things we do in everyday life. But this is especially true if you are a doctor today responsible for the management of a medical practice. Unfortunately, too many physicians go to work every day unaware of how better reporting can drive higher performance of their medical practice. The good news is by understanding three simple indices and metrics, any physician can begin to dramatically change the financial outcome of a medical practice and realize the return on investment of their efforts and an increased valuation of

Most Physicians Will Not Drop Payer Contract Despite Poor Pay

Only 19 percent of physicians in a recent survey said they would get rid of a payer contract if the reimbursement was poor. Provider organizations should be monitoring their payer contracts to ensure fair reimbursement, but most physicians still would not drop a payer if they were paying poorly, a recent Medscape survey found. The poll of 20,000 physicians across 29 specialties revealed that just 19 percent of providers would back out of a payer contract if the reimbursement rates were poor. But the majority of respondents said they would not abandon the payer despite reimbursement performance. Twenty-two percent reported that they

Patient Billing Challenges Revenue Cycle Management

Organizations can improve revenue cycle management by making patient billing processes more automated by using a modern payment systems. May 20, 2016 – Patient payment and billing are significant revenue cycle management challenges that should not be ignored.  According to a recent survey conducted by Navicure, 63 percent of participants recognized that patient payment processes were “a high priority” for the healthcare revenue cycle. “It is important to reexamine existing workflows and processes to adopt a more effective, automated patient payments process,” the survey said. Patient accountability was also major concern for participants, who reported having difficult time collecting payment from patients. About one-third of survey respondents

Overcoming the Top Challenges of Claims Denial Management Audits

Increasing efficiency and improving revenue are top priorities for health care providers with a big focus on improving prior authorizations and eligibility before an episode of care. Increasing efficiency and improving revenue are top priorities for health care providers with a big focus on improving prior authorizations and eligibility before an episode of care. However, leveraging data and consulting expertise to improve denials management can be something that most providers often overlook. Denial of a claim is the refusal of an insurance company or carrier to honor a request by an individual or provider to pay for healthcare services obtained from a

4 Medical Billing Issues Affecting Healthcare Revenue Cycle

Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle. Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform. The medical billing process can be a pain point for some providers because it involves an array of healthcare stakeholders and each step to getting paid relies on the previous interaction. Healthcare organizations must communicate across departments and payers as well as ensure that crucial information is properly captured in each step of the process. Despite the

Physician Shortage Drives Boost in Nursing, Physician Assistant Pay

Recent research shows compensation for nursing staff, physician assistants, and non-clinical employees is rising as provider organizations tackle the physician shortage issue. As the physician shortage worsens, provider organizations are increasingly relying on non-physician providers to fill the gap. And they are paying nursing staff, physician assistants, and other employees more to make up for it. The healthcare industry is facing a significant physician shortage, the Association of American Medical Colleges (AAMC) recently reported. The organization estimated a shortfall of up to 121,300 physicians by 2030 as the aging population seeks additional healthcare services and aging doctors retire. With substantial physician

Over 600 Individuals Charged in 2018 Healthcare Fraud Takedown

In the largest healthcare fraud takedown to date, OIG and DoJ reported charging individuals involved in fraud schemes that cost Medicaid and Medicare $2 billion. The HHS Office of the Inspector General (OIG) and Department of Justice (DoJ) recently announced the largest healthcare fraud takedown to date, with over 600 defendants charged with participating in fraud schemes amounting to about $2 billion in losses to Medicare and Medicaid. Of the over 600 defendants charged, 165 were medical professionals, including 32 doctors who allegedly participated in healthcare fraud schemes involving prescribing and distributing opioids and other narcotics. The charges jointly announced by the

Avoiding the Wide Net of Fraud Conspiracy Investigation

Protecting your company from a potential exposure, whether on the civil or criminal end, from the outside or from insiders, requires dedication to compliance. The word is out. There is money to be made in healthcare fraud—and not just in schemes by providers to steal payor funds, but by the government under federal and state statutes busting fraudulent conduct. How an action starts is really quite simple: maybe a former patient or employee reports a provider, or maybe a provider is just such a high utilizer of services that the conduct is brought to the attention of an oversight agency.