Using benchmarks to rate the success of your practice’s revenue cycle is an age-old “best practice.” No matter the specialty or size of your practice, it is important to periodically track, trend, and review performance data. It is the only surefire way to understand your financial strengths and weaknesses, and subsequently improve both.

One of the biggest challenges I’ve found, however, is that practices may think they’re adequately tracking certain benchmarks when they’re not. In reality, it’s not at all unusual for practices to be a little uncertain about whether they’re correctly calculating and analyzing important numbers.

So, I’d like to address two standard benchmarks that, in my experience, are particularly thorny: days in accounts receivable (A/R) and net collections percentage. It’s essential to track both accurately, because they demonstrate a practice’s ability to quickly turn over A/R and collect all money due. Let’s walk through: the definition of each term; the proper way to calculate each; an example calculation; and some common potential analysis pitfalls. Read More ›

Managing your revenue cycle is a daily need. Typically, a practice’s primary focus is on claim submission and denial management. While I agree that these two aspects are extrememly important, there is another aspect to revenue cycle management (RCM) that you may be overlooking, and it’s rapidly gaining in significance: eligibility verification.

Eligibility verification is one of those things many practices used to do once a year, when patients presenting for appointments would be asked to “update their files” by validating or filling out new insurance data forms. More recently, practices have adopted the procedure of periodically asking, “Is your insurance information still the same?” Read More ›

Join us on Wednesday, June 23 at 1 p.m. EDT for a complimentary webinar
to learn how the national trend toward consumer-driven healthcare is changing the way providers do business.

In under an hour, you’ll hear Pamela L. Moore, PhD, Vice President, Content and Strategy, UBM Medica and Physicians Practice discuss:

• The importance of quality, pricing and patient satisfaction as it relates to consumer-driven healthcare.
• How consumer-driven healthcare impacts your bottom line.
• Strategies for providers to increase patient collections at the point of service

Register now.

Running and working aging reports is a task that tends to be put on the back burner in many busy practices, but neglecting it can negatively affect the bottom line. When rejected claims get out of control and accumulate, two things can happen: 1) revenue can slow, and 2) you risk hitting timely filing limits (which could mean no payment at all for some of your claims).

Fortunately, there’s no reason to let the task become overwhelming—just make sure that your practice proactively tackles rejections by understanding how to run aging reports in your practice management system. This will allow you to run and work aging reports on a regular basis. A good rule to follow is that these reports should be run at least every 30, 60 or 90 days. By doing this, you can quickly see which claims remain outstanding, so you can take action to make sure they get paid. Read More ›

You’ve probably heard it before, but it is worth reiterating: Start preparing to transition to ICD-10 now. Most experts believe, with good reason, that the 2013 deadline will not be delayed. Those who are not prepared to correctly submit ICD-10 codes on the implementation date simply will not get paid.

The magnitude of the change is no small matter, either. The roughly 14,000 now-familiar ICD-9-CM codes will be replaced by about 69,000 ICD-10-CM codes; the current 4,000 or so ICD-9-PCS codes will swell to about 72,000 ICD-10-PCS codes. In all settings, physicians will need to provide much more explicit documentation. Read More ›

Thank you to everyone who attended our May 6 webinar
about how the transition to ICD-10-CM will impact your practice and what you can do to make the move as seamless as possible. During the one hour event, the American Academy of Professional Coders’ Vice President of Strategic Development, Deborah J. Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CDERC, CCS-P, discussed:

• The key steps you need to take to ensure ICD-10-CM/PCS implementation preparedness.
• Crosswalking examples and how the GEMs might impact your reimbursement.
• What documentation issues will need to be addressed prior to implementation.
• The impact the transition will have on the healthcare industry as a whole.

To learn more about the transition ICD-10 or to pass this webinar on to a colleague click here.

A seamless transition. That’s the goal we all seek in the colossal dual conversion of our HIPAA 4010 X12 files to the new 5010 standard, and the ICD-9 to ICD-10 code sets. Somehow, with a tight timeline and crunched budgets, we must simultaneously pull off two technically challenging migrations – and do it all with minimal disruption to business operations. The task, at times, feels overwhelming.

As you research your options, however, I’d suggest that one important place to begin is with a candid assessment of your organizational partnerships. The Herculean effort needed to successfully transition these two critical data sets at the same time will require close collaboration with trustworthy and responsive partners, each working within a well-defined area of expertise. Read More ›

In this age of automation, it’s tempting to rely on technology solutions alone to ease the burden of coding operations. And that’s OK; making coding easier is the primary purpose behind many of the coding and documentation tools available from leading EMR applications.

However, I’d like to offer a caveat: please don’t allow confidence in technology to detract from the value of self-audits. Technological aids don’t render coding and billing audits obsolete. As advantageous as some coding tools are, ongoing self-evaluation remains the single best way to ensure optimal coding practices – those that garner appropriate reimbursement while also protecting against payer investigations. Read More ›

Most providers and billing professionals understand the importance of tracking a practice’s “denied” claims—those for which insurers refuse to pay a dime. But there are other “hidden denials” that you also should be monitoring to prevent a slower, less obvious revenue drain.

I recently ran a report sampling more than five million claims and remits from late 2009, and found that about 7% were denied outright by payers. This is what I would call a traditional “denial” rate. Payers didn’t reimburse for any of the services on these claims.

A closer look at the denied 7% reveals that they cut across all types of diagnoses, from routine exams and vaccinations to cataracts and hypertension. Read More ›

Join us on Thursday, May 6 at 1 p.m. EDT for a complimentary webinar to learn how the transition to ICD-10-CM will impact your practice and what you can do to make the move from a system with 14,500 codes to a system with over 69,101 codes as seamless as possible.

In under an hour, you’ll hear the American Academy of Professional Coders’ Vice President of Strategic Development, Deborah J. Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CDERC, CCS-P, discuss:
•    The key steps you need to take to ensure ICD-10-CM/PCS implementation preparedness.
•    Crosswalking examples and how the GEMs might impact your reimbursement.
•    What documentation issues will need to be addressed prior to implementation.
•    The impact the transition will have on the healthcare industry as a whole.

Participants can earn 1.0 Continuing Education Unit (CEU) from the American Academy of Professional Coders (AAPC) by attending*.

Register now.

*This program has the prior approval of the American Academy of Professional Coders (AAPC) for one continuing education hour. Granting of prior approval in no way constitutes endorsement by the AAPC of the program content or the program sponsor.