Category Archives: iMAX Medical Billing Insights

How to diagnose cash flow problems in your practice

Cash is the lifeblood of your practice. Recognizing how much money you have and where it is going is key to the survival of any business. It doesn’t matter if you’re running a multi-specialty clinic or a lemonade stand. The ability to predict and deal with cash shortfalls is critical to your practice’s longevity. Your understanding begins with three important financial reports. Three reports you should be looking at The income statement is the first report you will want to examine. This report shows the cash generated from your practice’s core business operations. Avoid focusing on the bottom-line figure, the net income.

6 strategies for better billing and collections

It’s that time of year again when everyone is planning ways to make the upcoming year their best year yet. If your practice is like most other practices, then one area where you could use some work is billing and collections. Here are six resolutions that can improve your billing and collections in the new year. Resolve to educate your patients. Insurance is complex and is getting more so. Physicians and their staff are now spending a lot of time on continuing education when it comes to billing. But patients could use a bit of schooling, too. Copays, deductibles, and

Ohio to rebid costly private Medicaid contracts

Dayton-based CareSource handles over half of state’s insurance plans. Gov. Mike DeWine wants to rebid the state’s contracts with private health insurance companies that manage billions of dollars of Medicaid benefits. About 1 in 4 Ohioans — 2.8 million people — are covered by Medicaid, which has a $28.2 billion budget for fiscal year 2019. The low-income insurance program is funded with a mix of state and federal dollars. But the majority of the money spent isn’t directly paid out for health care services. Instead, the money goes to private health insurance companies that are contracted to the state to

New anti-kickback provisions impact laboratory-physician relationships

Until recently, arrangements between physicians and commercial laboratories escaped federal anti-kickback rules because the arrangements did not involve government payers. But with passage of the Eliminating Kickbacks in Recovery Act of 2018 (EKRA), physicians will need to review their standing arrangements and ensure compliance. EKRA is Section 8122 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which was signed into law on October 24, 2018. EKRA establishes an all-payer anti-kickback prohibition that extends to arrangements with recovery homes, clinical laboratories, and clinical treatment facilities. The intent of Section 8122 is to address the opioid

Personal branding for doctors: Being yourself can enhance your practice

People draw conclusions from every instance of your name being mentioned. Your brand is the way you are currently perceived as a doctor, but branding is not marketing. Put simply, personal branding is about being authentic and delivering value. A clearly defined and managed brand is important for doctors. Branding is becoming increasingly crucial in today’s world, even beyond the corporate workplace. Whether you work in a hospital or other healthcare setting, your branding is already evident to everyone you interact with. Something as small and seemingly insignificant as your listing on your hospital’s or practice’s website communicates information about you. If

Work-life balance for physicians: The what, the why, and the how

Burnout rates and physician dissatisfaction are at an all-time high. Work-life balance is the buzzword answer often cited to solve these problems, but incorporating “life” into a physician’s career is easier said than done. The Cambridge dictionary defines work-life balance as “the amount of time you spend doing your job compared with the amount of time you spend with your family and doing things you enjoy.” For physicians, the concept of work-life balance is not so straightforward, as highlighted by Siva Raja, M.D., from Cleveland Clinic Foundation in Ohio, and Sharon Stein, M.D., from University Hospital Case Medical Center also in Cleveland, OH. “In

CMS Delays E/M Coding Changes in New Physician Payment Rule Also expands telemedicine coverage, cuts Part B drug reimbursements

Physicians hoping the Centers for Medicare & Medicaid Services (CMS) would modify some proposed changes to evaluation and management (E/M) codes got their wish Thursday when the agency issued its final Physician Fee Schedule rule for 2019. CMS also announced changes to Part B drug payments and new telehealth options. When CMS first proposed an overhaul of the E/M coding structure in July, the agency argued that it was reducing clinicians’ administrative burden by collapsing payment levels 2 through 5, and offering “blended payment rates” along with certain add-on codes. But provider groups were not impressed. More than 160 medical organizations, including the American

Trump Administration: Ease Scope of Practice Laws Also takes aim at “certificate of need” regulations

Easing scope-of-practice laws and streamlining graduate medical education (GME) funding would make U.S. healthcare more competitive and efficient, the Trump administration said Monday. “Reduced competition among clinicians leads to higher prices for healthcare services, and reduces choice… Government policies have reduced competition by restricting the available supply of providers and restricting the range of services they offer,” said a senior administration official, speaking on the condition of anonymity, during a call with reporters to discuss a new report called “Reforming America’s Healthcare System Through Choice and Competition.” President Trump called for the report, issued jointly by the departments of Health

Price Not the Only Driver of High Healthcare Costs, Research Shows

The reasons behind total healthcare costs vary by region, so local leaders need reliable data to truly bend the cost curve, a new study shows. November 12, 2018 – Healthcare costs in Colorado are significantly higher compared to other states in the country. A recent analysis by the Network for Regional Healthcare Improvement (NHRI) showed that total cost of care in Colorado was 19 percent higher than the average costs in six other states. Greater utilization and prices drove the higher-than-average healthcare costs in Colorado. The rate of healthcare utilization in the Mountain state was five percent higher than the six-state average, and prices were

NP, PA Office Visits Grow 129%, But Healthcare Costs Still Rising

The overall rate of primary care office visits also fell 18 percent, but the trends did not necessarily result in healthcare cost savings, HCCI reported. Office visits to primary care physicians dropped 18 percent from 2012 to 2016 among non-elderly adults with employer-sponsored healthcare coverage, the Health Care Cost Institute (HCCI) recently reported. “The decline in primary care visits comes at a time when awareness has grown of the role of primary care in prevention and in containing overall medical spending,” Niall Brennan, President and CEO of HCCI, stated in a press release. “We saw these trends in our annual report