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Welcome to the medical billing blog containing news and articles relating to medical billing, medical coding ICD-10, HIPAA and all practice management functions.

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Currently contains over 1,235 healthcare and medical related entries.

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RCM tip: Focus on field training in an IDN environment

Healthcare providers operating within integrated delivery networks should pay attention to field training as they manage a central business office, according to Kenneth Miller, Senior RCM Specialist at Cantata Health. Mr. Miller shared this tip with Becker’s Hospital Review. “Ongoing education is key to ensure financial success. Without an education department, it is impossible for IDNs to ensure field staff and registrars are doing what the leadership team expects of them. Trainers must be sent out to the field on rotation to certify staff are following through on verification, maintaining the required financial paperwork, and communicating with patients as appropriate.” Beckers is seeking article topics and tips…. If you would

Published By: Melissa Clark, CCS-P, RT | No Comments

EHR Use and Administrative Burden Accelerate Burnout

In response to a new study about high levels of physician burnout among family physicians, Ohio State University Wexner Medical Center family physician Donald O. Mack, MD, suggested the recent transition to a value-based care system and increased EHR use may have augmented the problem. “Burnout is associated with lower patient satisfaction and care quality, higher medical error rates and malpractice risk, higher physician and staff turnover, physician substance abuse/addiction, and physician suicide,” he wrote. “The causes are numerous, and in many cases physicians point to the increasing demands of electronic medical records, quality metrics, administrative tasks such as prior authorization, and value-based payment requirements, which take time away from

Published By: Melissa Clark, CCS-P, RT | No Comments

RCM tip: Identifying the root causes of denials

Discovering the reason for a hospital claim denial can help healthcare organizations improve revenue cycle performance, according to Susan Eilman, senior healthcare consultant for revenue cycle transformation at Hayes Management Consulting. Ms. Eilman shared the following tip with Becker’s Hospital Review. “Recently I was working with a revenue cycle director who researched root causes for registration and eligibility denials and identified a specific clinic with a denial rate of 42 percent. This director contacted the clinic and asked the clinical director, ‘Why does your location have a denial rate of 42 percent due to registration and eligibility denials when the industry standard is less than 5 percent?’ The clinical director

Published By: Melissa Clark, CCS-P, RT | No Comments

RCM tip: Invest in automated rules engine to improve RCM

Investing in automation tools, such as a rules engine, can help healthcare organizations decrease their administrative workload, according to Andrew Wade, practice administrator at Conway, S.C.-based Coastal Orthopedics. Mr. Wade shared the following tip with Becker’s Hospital Review: “If we want to truly free up providers from administrative burden and empower them to do the work they love to do — spending more time with patients and delivering quality care — organizations need to invest in tools that automate tasks wherever possible. Thanks to our technology’s rules engine, our claims can be automatically verified and some errors automatically resolved based on knowledge gleaned from the network. We are getting cleaner

Published By: Melissa Clark, CCS-P, RT | No Comments

MIPS: The Day of Reckoning

One of my favorite books is The Big Short by Michael Lewis. It was eventually made into a movie by the same name and gives a clear view of the housing bubble that burst 10 years ago and pushed the US economy into the Great Recession. What fascinates me was the ability of some to predict, and profit, from knowing when the collapse would occur. They were able to delve into the details of millions of mortgages and see when the adjustable rates would suddenly increase leading to escalating mortgage payments and boosting the default rates dramatically. The subsequent collapse was unavoidable, and predictable. What does this have to do

Published By: Melissa Clark, CCS-P, RT | No Comments

Newly-Designed EHR Notes May Improve Usability

Showing less data in physician EHR notes may produce more benefits for physician productivity, according to a recent study published in the Journal of the American Board of Family Medicine (JABFM). The study by Jeffery Beldon, MD et al. compared different physician EHR note designs to see which design physicians found most efficient, accurate, and usable when attempting to obtain information for ambulatory chronic disease care. Researchers devised four physician note designs and tested the designs on 16 primary care physicians in random order. Physicians were instructed to find key information in the EHR notes during timed tasks. Physicians then gave each note design a usability rating and new feature

Published By: Melissa Clark, CCS-P, RT | No Comments

7 strategies to prevent claims denials

Claims denials pose a serious issue for hospitals amid an already complicated reimbursement landscape. “Denials are a huge obstacle to timely and complete reimbursement,” said Carmen Sessoms, associate vice president of the revenue cycle management advisory services program at Nashville, Tenn.-based Change Healthcare. In 2016, Change Healthcare managed 1.8 billion transactions with a value of more than $3 trillion. Leveraging this data, analysts determined approximately 9 percent of claims with a value of $262 billion were denied. These denials impacted about 3.3 percent of net patient revenue, translating to an average of $4.9 million per hospital. Denials are not only highly prevalent in the healthcare environment, but also very costly

Published By: Melissa Clark, CCS-P, RT | No Comments

Hypertension Coding in the Age of Quality

The hypertension “epidemic” hearkens back to boxer Joe Louis’ words regarding a smaller, quicker opponent — light heavyweight Billy Conn, “You can run, but you can’t hide!” No matter what specialty of medicine or surgery you practice, or whether you are a primary-care provider, elevated blood pressure represents a recurring problem that will not go away. Furthermore, hypertension is often accompanied by comorbid conditions such as diabetes mellitus, obesity, CKD-3, and systolic dysfunction which complicates blood pressure treatment, according to researchers at University of Miami Miller School of Medicine. The downside of this epidemic is clear, untreated blood pressure is fraught with multiple target organ complications. In fact, approximately 80

Published By: Melissa Clark, CCS-P, RT | No Comments

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