iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

Managing your payer mix to improve your bottom line


Your bottom line is a function of the money you receive and the money you spend. This article is the first of a two-part series that focuses on one facet of how your payer mix impacts your revenue. Before we discuss the importance of payer mix, let’s review some revenue math. A dollar charged is not a dollar earned because the dollar just doesn’t go that far in a medical practice. You get the sum of the co-pay, the deductible and what the patient’s insurance pays, but that rarely equals the amount you charged. That’s part of revenue math, where



Improve patient collections through billing transparency


An overwhelming majority (92 percent) of patients want to know their payment responsibility prior to visit. This statistic, from InstaMed’s seventh Trends in Healthcare Payments Report, highlights the recent shift in patient financial engagement. Patients have become consumers who seek transparency and flexibility when paying for healthcare expenditures. However, medical groups are lagging when it comes to meeting consumer expectations of identifying, and collecting, out-of-pocket liability. Technology solutions are beginning to make accurate patient estimates a scalable solution to not only identify but help medical groups engage in best practices for collections. Patient cost identification should focus on more than running patient eligibility



The leading causes of denials and how to prevent them


Each new denial is essentially a revenue leak. Even when claims are recovered, the costs associated with that recovery must be subtracted from patient revenue. Recent data put that recovery cost at roughly $118 per denial. Factor in the lost revenue from your unrecovered claims and it’s clear why denials are a painful financial drain on practices.   What makes denials so frustrating is that many are avoidable. The leading causes are well known, and it’s possible to prevent these leaks before they occur. The key is having processes in place to identify and correct errors and omissions before a problematic claim is ever



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



The Front Desk: Your Defense Against Claims Denials


Whether or not a claim is paid or denied has a lot to do with what happens before a patient walks through the door. Incomplete or inaccurate information gathered on the front end can set the stage for a denial before a visit even gets started. “It’s critical to have as complete a patient record as possible before a patient presents,” said Ben Colton, senior manager specializing in revenue cycle optimization at ECG Management Consultants in Seattle, Wash. “As the visit gets closer, you should use all lines of defense to verify information right up to the time of the



Provider Payment Mechanisms May Influence Low-Value Care Use


Fee-for-service providers in the Military Health System were more likely to order 11 of 19 low-value care services compared to salaried providers, a new study shows. A new study in Health Affairs found evidence that patients in the Military Health System received potentially low-value care, but the amount of low-value care varied by how the providers were paid. Researchers defined low-value care as overused or inappropriate care. Such care included procedures and treatments that were clinically inappropriate or inappropriate for a certain population (i.e., prescribing antibiotics for viral infections or cardiac stress imaging in low-risk or asymptomatic patients). Low-value care in the analysis also



Physician Assistant Compensation Up 1%, Showing Workforce Growth


The AAPA reports that median base physician assistant compensation rose from $105,000 in 2017 to $106,000 in 2018, outpacing inflation over time. Median base physician assistant compensation increased from $105,000 in 2017 to $106,000 in 2018, representing one percent growth during the period, the American Academy of PAs (AAPA) recently reported. The report, which surveyed 13,088 physician assistants between February and March 2019, also showed the median compensation for physician assistants including base salary, hourly wages, and other forms of productivity pay. In 2018, the median compensation for physician assistants across the entire profession was $107,500. Although compensation varied by specialty



Medical Group Operating Margins Improved in 2018


In terms of medical group operation margins, total profit per physician in independent practices increased, while integrated health systems lost less money per physician. Medical group operating margins for integrated systems and independent practices improved from 2017 to 2018, according to new data from AMGA. The association’s 2019 Medical Group Operations and Finance Survey, which used data from medical groups representing over 15,300 provider FTEs, showed that median total investment per physician in integrated systems improved 21 percent, decreasing from $243,918 in 2017 to $201,042 in 2018. Independent practices also saw a slight improvement in total profit per physician during the



Demand for Medical Specialists Increases, Surpassing Primary Care


Recruiting assignments for medical specialists increased to 78 percent in 2019 as demand for primary care physicians declined, Merritt Hawkins reported. Hospitals, medical groups, and other healthcare organizations increased their demand for medical specialists from 2018 to 2019 despite the industry-wide push for more primary care, according to Merritt Hawkins’ annual report on physician recruiting and incentives. The report, 2019 Review of Physician and Advanced Practitioner Recruiting Incentives, showed that 78 percent of Merritt Hawkins’ recruiting assignments from April 1, 2018, to March 31, 2019 were for medical specialists, including psychiatrists, OB/GYNs, and radiologists. The number of recruiting assignments for medical specialists is



Q/A: What’s the Difference Between Q5 and Q6 for a Substitute Provider?


Question In the situation of a locum tenens/substitute provider, can you help me understand the difference between the Q5 and Q6 modifier and when it would be appropriate to use each one? Answer It’s important to understand that these modifiers are not interchangeable. These modifiers recently had their descriptions changed to clarify some of the problems previously associated with them. Use Q5 when there is a reciprocal billing arrangement and use Q6 when there is a fee-for-time compensation arrangement. Medicare has some specific rules about the time involved so be aware of individual payer policies and their time requirements.