The New Year always brings new challenges for healthcare organizations, and 2012 is no exception. Case-in-point: The transition to 5010 is already testing the financial health of practices—and that only took effect on January 1.

While much of the 5010 transition seems to have progressed smoothly, it’s imperative that practices across the nation carefully monitor their cash flow and bottom line throughout the year to make sure that this trend continues. Spikes in rejections and denials, for instance, can be the first warning signs of problems—and may or may not be related to the 5010 transition.

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Thank you to everyone who attended our latest webinar on January 5, Reimbursement Reality 2012: The Challenges – and Opportunities – for Medical Practices. Nationally recognized revenue cycle expert and author Elizabeth Woodcock, MBA, FACMPE, CPC, led the one-hour event, which focused on the challenges and opportunities reimbursement and payment programs offer for medical practices in 2012. During the webinar, she offered advice about how to:

• Leverage the key changes in 2012
• Manage the increase in patient financial security
• Successfully participate in the government’s incentive payment programs

To learn more about how your practice can stay as profitable as possible in 2012, click here  to download this webinar.

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Almost every industry article written today about revenue cycle focuses on how to streamline and improve the process. Although there are a lot of ways to streamline a practice’s revenue cycle, in my practice experience, I found that consistently implementing three key activities can help enhance staff workflow, reduce claim denials, and ultimately improve a practice’s bottom line.

The first of these activities is verifying insurance. While this may seem like a self-evident step, many practices neglect to perform this critical task—and for understandable reasons. Many practices simply don’t have the staff resources for what too often is still a manual chore. If they do perform it, practices often wait until the patient is standing at the front desk.

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In today’s economic environment, the timely collection of all earned revenue is not a luxury—it’s a necessity. That’s true for all practices – not just specialty ones. At Regional Urology Enterprise, for example, I’ve had to navigate the revenue pitfalls associated with imaging and radiation treatments. What I’ve learned, though, is practices that leverage technology to improve efficiency, streamline workflow, and proactively identify and respond to systemic issues can ensure they collect all the money they earn.

I consider my practice’s automated clearinghouse as one example of technology that kills two birds with one stone: it improves our overall performance while it also enhances the bottom line. We use it in a variety ways, but most notably to:

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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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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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After 18 years managing all aspects of the revenue cycle within the healthcare industry, I’ve noticed many practices often submit claims to insurance companies only to later receive a denial because they didn’t include a key element that the payer requires—an element they didn’t even know  had to be included. In frustration, the practice fixes the issue and resubmits the claim, then moves on to the next claim. This effort costs valuable time and delays cash flow. But what have they learned?

The key to effective cash flow is to really manage denials, not just resubmit claims. In today’s healthcare environment, it’s important for practices to avoid examples such as the one above by taking just a little time to understand claims processes from the payers’ perspective. After all, payers don’t decide the care a patient should receive. Their role is simply to: 1) identify what they will reimburse, and 2) set guidelines for how they will reimburse.

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As manager of collections and reimbursement for Radiation Oncology Services of America (ROSA, Inc.), I am constantly thinking about ways to enhance the collections process and speed up reimbursement. Although there are many good practices worth considering when trying to improve the reimbursement process, the following are a few I’ve found to be most beneficial:

• Foster good relationships with front end staff. Our organization has a centralized billing office that works claims for all of our 16 radiation therapy locations. This means that we at the billing office are geographically separated from the clinics with which we work. Because of this, it’s critical we maintain a good working relationship with front end staff based on mutual respect and effective communication. That way, everyone is on the same page about what is needed to support a clean, efficient, and successful claims process. For example, a good working relationship helps ensure that front desk staff understand the importance of collecting and sending accurate patient demographic and insurance information. Read More ›

When a claim is denied, one of the first questions you should ask yourself is whether prior authorization was obtained for the services listed on the claim. If the answer to this question is “yes,” then you have to dig deeper to determine why it was denied—and how to prevent such denials in the future.

Unfortunately, claims with prior authorizations are denied more often than you might think. There are five common reasons for these denials that you should take into account and ways to avoid them:

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