According to an April New York Times article, healthcare spending in the United States has slowed significantly over the past few years. Numbers from the Centers for Medicare and Medicaid Services (CMS) show that in 2009 and 2010 total nationwide spending grew less than 4 percent per year, representing the slowest annual growth in more than 50 years. Although this slowdown may not seem unexpected given the current state of the economy, it has been sharper than experts anticipated, pointing to the possibility that factors other than the recent recession also affect spending. This is significant because it may mean the slowdown will continue even as the economy picks up. However, there is good news and bad news with flattened spending.

On the positive side, it could lessen the impact of healthcare costs on household budgets and ultimately strengthen the country’s fiscal health. For example, if Medicare spending grows only 1 percentage point faster than the total economy, the long-term deficit for the United States could fall by more than 33%. On the other hand, reduced spending means less income for hospitals, physician practices and other healthcare organizations. In a time when cost margins are already tight, lessening income could be potentially damaging for many organizations.

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Practices that want to thrive in the current healthcare environment must have deep insight into their performance on key revenue cycle metrics. That’s why Texas Retina Associates—a 14-office sub-specialty ophthalmology practice—began looking for ways to easily quantify rejections and denials. The group wanted to be able to scrutinize the data and identify opportunities for improvement.

The goal was to proactively address any trends in the revenue cycle that were negatively affecting the number of rejected and denied claims. The practice believed that uncovering the root causes of rejections and denials would have a powerful impact on the entire revenue cycle.

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Keeping up with the nuances of the changing reimbursement landscape can be challenging. As the second quarter of 2012 approaches, practices continue to grapple with different aspects of Medicare reimbursement. Some of the most confusing relate to health risk assessments, annual wellness visits, electronic health records and electronic prescribing. To help, here’s a quick overview of those topics, along with links you can reference for more information:

Health Risk Assessment (HRA). The Affordable Care Act (ACA) requires physicians to perform a health risk assessment (HRA) as part of an annual wellness visit for Medicare beneficiaries. Providers from any specialty can perform an HRA as part of an annual wellness visit. There is no specific form associated with the HRA; the Centers for Medicare and Medicaid Services (CMS) leaves it up to the physician on which form to use. For more information about the HRA, visit this link.

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It’s that time of year again. Medicare fees are in danger of being slashed for 2012 and your revenue will be impacted.   Bah humbug! Since Medicare is a huge payer, almost every medical organization across the country will feel the impact of any cuts that are made. So, it is important to know how to quickly calculate the potential impact on your overall electronic payment revenue.

For this blog, I am going to use the following formula to determine the percentage impact to overall monthly electronic payment revenue:

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2012 will bring many new challenges and opportunities for managing reimbursement and payment programs at medical practices. Are you prepared to help your practice avoid pitfalls and take charge in the coming year?

Join us on Thursday, January 5 at 1:00 pm EST, for a complimentary webinar, Reimbursement Reality 2012: The Challenges – and Opportunities – for Medical Practices. Register Now.

During the one-hour webinar, nationally recognized revenue cycle expert and author Elizabeth Woodcock, MBA, FACMPE, CPC, will offer advice about managing the reimbursement environment and will discuss:

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Keeping on top of your revenue cycle is not a once-a-week or twice-a-week job. Every day, practices should enter charges, submit claims, and work any rejections and denials. The more attention these various efforts get, the faster your practice will get paid.

Setting expectations is the key—especially in a busy office with so many other pressing duties to attend to. The only way to ensure a constant flow of revenue is to set expectations for physicians, coders, and billing staff regarding timeliness and efficiency.

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For a long time, the practice I work at – North Platte Nebraska Physician Group – used a clearinghouse that made us feel as if we were sending claims into thin air. Although we were sending claims electronically, we never knew where they were in the processing cycle. Too often, we found ourselves bumped up against timely filing limits that hurt our reimbursement.

So we searched for a new clearinghouse that would provide the tools and the customer service we needed to improve our financial picture. After an in-depth review of our options, we selected an Internet-based organization for its terrific customer service, plain English reporting, and easy ability to view claims all the way through the revenue cycle. This new system has helped cut our timely filing reductions, decrease the number of duplicate claims, and improve our accounts receivable (A/R) tremendously.

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Practices nationwide are being asked to accept more financial responsibility with patients and payers. As you tackle these challenges, it’s more important than ever to ensure your workflow is running at an optimal level. In this complimentary learn six specific workflow strategies that can help any practice improve overall efficiency, which will ultimately strengthen a practice’s bottom line.

Join us on Wednesday, May 25 at 1:00 PM EDT, for a free webinar: 6 Workflow Tips to Improve Practice Efficiencies.

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Most practices diligently track denied claims because of the impact they have on revenue; however there are other types of denials – hidden ones – that often fly under the radar while slowly draining revenue. In this complimentary webinar learn how to maximize your reimbursement by identifying and tracking these “hidden denials.”

Join us on Wednesday, April 20 at 1:00 pm EDT, for a free webinar: Hidden Denials and Appeal Letters: Tips and Tricks to Maximizing Your Reimbursement.

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Thank you to everyone who attended the January 13 webinar, Reimbursement Reality 2011: The Challenges – and Opportunities – for Medical Practices. During this one-hour event, Elizabeth Woodcock, MBA, FACMPE, CPC, discussed the key reimbursement changes for 2011 and how to use those changes to your benefit; how to manage high-deductible health plans; and how get the most out of government incentive programs such as PQRI.

To learn more about reimbursement changes for 2011 and how they will impact your practice, click here to download the recorded webinar.