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Don’t Be Hesitant About Collecting Co-Pays
February 1st, 2018 - Christine Taxin
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
Adjusting Your Collection Strategies to HDHPs
January 31st, 2018 - Ashley Choate
High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....

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NEW Mandatory ABN Form to Take Effect June 21, 2017
August 17th, 2017 - Mario Fucinari DC, CCSP, CPCO, MCS-P, MCS-I
The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form. The revised Advanced Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be ...
Inpatient Compliance: Split-Shared Services
June 23rd, 2017 - Grant Huang
In the inpatient setting, a physician can combine his or her documentation with that of a non-physician provider (N.P.P.) to support an E and M service while billing the resulting code under the physician. This is called a “split-shared” service and allows physicians to bill at 100% of the fee ...
Are harder times coming for CFOs? A data driven answer [Infographic]
October 13th, 2016 - Ango Mark
“We really do believe much harder times are coming from a reimbursement standpoint”, Daniel Morissette, Stanford Health Care CFO. With value based model, the most unpredictable payment reform, in their list of financial challenges, CFOs point out their threats and decision making...
23 RCM questions you should ask when reviewing a medical billing company
September 29th, 2016 - Ango Mark
So, you have considered taking on the challenges of finding the best medical billing company for your medical practice. We should all by now know that the healthcare industry’s reimbursement laws aren’t going to stay put and be as they are. The changes they undergo are constant and...
3 Steps To Be As Successful As University Of Virginia’s Medical Group Practice.
July 19th, 2016 - Adam Smith
How keeping track of the key performance indicators has given this group practice an edge over its competitors in handling the revenue cycle… The shift to value-based economic systems has de-stabilized many healthcare organization’s economic dispositions. Group practices endured...
Net Collection Ratio
December 29th, 2015 - Codapedia Editor
The net collection ratio is a calculation that shows the practice how much money they are collecting of the money, which they could have collected after insurance adjustments. It is an excellent measure of how well the practice is doing in collecting accounts receivable.
The Critical Role Of Hospital CFOs: A Data Driven Answer [Infographic]
October 6th, 2015 - Adam Smith
We know the evolving role of CFOs in the healthcare industry. There are situations which have forced the executives to make such decisions like changing the vendor, attritions and outsourcing one or more of their processes. There could be ample reasons like transition to value-based model, slow...
When patient doesn’t pay health exchange premium, you may be left holding the bag
September 3rd, 2014 - Scott Kraft
One of the issues surrounding implementation of the Affordable Care Act (ACA) that impacts physician billing and payment and hasn’t gotten a lot of attention is what happens when a patient buys an insurance plan under the exchange, but then stops paying the premium. The answer may end up...
Win The Losing Battle-Verify
August 5th, 2014 - Donna Weinstock
Do you feel like you are fighting a losing battle? Are you watching your account receivables going up and your collections going down? Is your cash flow suffering? What is a practice to do? One of the most effective ways to keep your cash flowing is by checking your patient’s...
Medicare Part B deductible, premiums to be unchanged for 2014; tips on deductible collection
October 31st, 2013 - Scott Kraft
The Medicare deductible for Part B services will not change in 2014, remaining at $147 for the second straight year. The premium for beneficiaries will also remain unchanged at a base rate of $104.90, continuing the slowest five-year period of premium growth in Medicare Part B history, according to...
Hospital Observation Services
August 28th, 2013 - Dorothy Steed
Hospital observation services are considered outpatient services. They are typically used when a period of time is needed to evaluate the progress or regression. This may include effectiveness of medication/ infusions, results of diagnostic results or other reasons deemed as medically necessary....
Charging Medicare Patients for Missed Appointments
June 20th, 2013 - Cyndee Weston
Previously, each Part B office had their own requirements regarding charging Medicare patients for missed appointments. TRICARE (TriWest Healthcare Alliance) regulations required providers to establish office practice policies regarding "no show" fees and required beneficiaries to sign an...
Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program
June 20th, 2013 - Frank Murphy
Increasing cash flow through the use of a modern, third-party collection agency is a must for practice survival. With states reducing government funding and third-party payers reducing allowables, more and more dollars are being transferred to patient responsibility. Practices now must trim...
Get Started Going Paperless
May 15th, 2013 - Debra Sanders
Do you get a lot of emails and some you need to keep, some delete? Or maybe you have some documents in your drawer you reference once in a while but you have nowhere else to keep them but in your drawer or pinned on your walls? If you use Outlook Express at work, it's pretty much the same as...
Keeping Track of Your Surgeries
March 22nd, 2013 - Debra Sanders
When working my AR, I work my surgeries separately since that is my big money or bulk money. I want to make sure I get that money in as quickly as possible. For me, I created an excel spreadsheet. The columns are: DOS - PATIENT NAME/MRN - PROC NAME - CARRIER(S) - CPT® - MODIFIER - BILLED -...
No Claim Left Behind
March 22nd, 2013 - Shannon Bosley
Call me crazy, but it is always exciting to me when I assist a practice in getting reimbursed on unpaid or delinquent claims. Claims that were denied, viewed as uncollectable, past filing deadline, or a multitude of other reasons. I even have a little dance that I do! Why not? We need to get...
Why Get Into Medical Billing?
March 22nd, 2013 - Debra Sanders
I am asked alot or read alot where people want to get into medical billing. Some have gone to school and some haven't. Either way, there is more to it than just saying, I want to do that. I've been in this field for over 15 yrs and still learn something new every day. I even learn something I...
Using denial tracking to improve collections
April 10th, 2009 - Codapedia Editor
Here are some examples of denials that a practice should track to be sure that they are paid correctly by the insurance company. Set up a denial type for each of these. Fee Schedule Issues: Wrong amount paid per the contracted fee schedule. May be too high or too low Modifier 80...
Real Time Claims Adjudication (RTCA)
March 31st, 2009 - Codapedia Editor
Real time claims adjudication (RTCA) is a software interface between a physician's practice management information system and a payers claims processing system that allows the practice to submit a claim at the time of checkout, and receive a response from the insurance company while the patient is...
Denial tracking
March 30th, 2009 - Codapedia Editor
Claims denials have the following outcomes, none of them good: Collection of revenue is delayed Collection for the service never happens Staff members spend time and energy researching and resubmitting claims The denial is lost in the A/R system and never worked There are...
Copying insurance cards
March 30th, 2009 - Codapedia Editor
Is your office copying insurance cards? I have three words of advice: Just stop it. I am amazed at how often I see front desk staff doing this. They ask for the card. Get up from the desk. Walk to the copier. Hopefully, no one else is using it right then. Copy the front. Wait. Take the copy...
The cost of no-shows
March 30th, 2009 - Codapedia Editor
What is a no show in your practice? a huge relief: now we can get caught up lost revenue you can never make up Of course, the answer is both. From a financial perspective, it is critical to keep no shows to a minimum. It is a good idea to track no-shows, to see what they are costing...
Registration policies
March 30th, 2009 - Codapedia Editor
Years ago, we scheduled patient visits in a big book, penciled in the patient name, phone number and reason for the visit. We were done. Now, most practices are using a computerized scheduling system, that allows more than one person to schedule at once (remember passing "the book" back...
Eligibility
March 30th, 2009 - Codapedia Editor
One of the most common sources of denials in physician practices is "patient not eligible for this date of service." The patient presents with an insurance card, the office copies the card, and stores the information. The practice provides service, and perhaps collects a copay, and then...
Telephone calls: CPT® codes with no reimbursement
March 10th, 2009 - Codapedia Editor
Search the Medicare Claims Processing Manual, Chapter 12, for the word "telephone" and the sentences are filled with negatives. Here's the section from the Manual labeled telephone calls: B. Telephone Calls Telephone calls (codes 99371-99373) may not be paid separately. Payment...
How to analyze and diagnose a low collection rate
March 5th, 2009 - Elizabeth Woodcock
Woodcock & Associates has provided a diagnostic tool for you to download. Click the Resources link above to get the PDF file.
Days in Accounts Receivable
February 15th, 2009 - Codapedia Editor
Practices should monitor their days in accounts receivable monthly and compare their days with the average days of other practices by specialty. Days in Receivables Outstanding: A/R/(last 3 months of gross charges/90) = Days in A/R Example: 3 months of charges= $927,009; A/R = 567,828 Average...
Aging Report
February 15th, 2009 - Codapedia Editor
Run your aging report every month in summary and in detail by payer class. A good goal is to have less than 20% of your total accounts receivable 120 days or older. Practices with great accounts receivable policies and procedures can have a lower percentage than this. Remember, young is good in...
Accounts Receivable Benchmark Data
February 6th, 2009 - Codapedia Editor
Accounts Receivable benchmark data includes a measurement of the gross collection rate, the net or adjusted collection ratio, an aging report, or an aged trial balance and the total days in accounts receivable outstanding. It is critical for physician practices to measure and track this data on a monthly basis and to compare that data with national standards.
Completing encounter forms
January 29th, 2009 - Codapedia Editor
“Collecting the money is out of my hands.” How many times have we heard physicians express this sentiment, both as wishful thinking and as a statement of fact? Physicians often overlook the most important step in the billing and collection process: telling the billing office what...
Gross Collection Ratio
January 28th, 2009 - Codapedia Editor
The gross collection ratio is shockingly low for many practices. Physicians do not understand why they collect only 20, 40, 60 or 80 cents on the dollar. The percentage of collections based on the gross charges varies significantly by practice and specialty. It is influenced by a number of...

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