Medical Practice Billing Check-up for 2015

Believe it or not we are now more than half-way through the year 2015. This is probably a good time to conduct a medical practice billing check-up. We know it’s not a newsflash, but change is the only constant in healthcare. Have you made progress addressing some of the big issues that promised to impact your medical practice billing and collections this year?

The elephant in the room is ICD-10. Whether or not you have had the time to prepare; it looms ahead, ready for implementation on October 1. CMS says a claims test with approximately 500 stakeholders submitting 13,700 test claims went well; 87% percent* of the ICD-10 test claims were accepted. Is your staff, including your physicians and surgeons, trained in ICD-10? Have you updated your EHR and your billing software to accommodate new ICD-10 forms and requirements? MICI is ready to help. Our full medical billing service team will appear at your door and help make your practice ICD-10 ready while you care for your patients.

The enormity of ICD-10 can easily overshadow other issues, but a check-up on some other key impacts to your medical billing and collections is probably a good idea:

Medical Practice Price transparency: This is a complex issue, but one that is gaining more steam across the country. Revealing prices for medical procedures is a complex task, especially for hospitals. Has your state considered enacting legislation requiring physicians and other providers to publicly list pricing for common medical procedures and tests? If so, are you prepared to get your pricing ready for its public debut?

Patient Collections: The ACA has created a bottleneck of confused (and under-informed) newly-insured people who do not understand their financial responsibility for health care. Have you trained your staff to improve your patient collections for medical bills either by collecting co-pays at the time of treatment, setting up payment plans at time of patient arrival, and/or offering payment options including online bill pay? How have you made patient payments easier to understand and easier to complete? Are you using patient-friendly billing standards?

Physician Contracting: ICD-10 will create pressure on payers to be very conservative in their medical claims payments. Increasingly insurance companies are going to want you to enter risk-based contracts based on some type of risk-adjusted payment method. Have you faced this at the 2015 negotiating table? We’ve got your back on this. It’s what we do every day for our clients; negotiate smart contracts that protect your medical practice while providing optimal reimbursement.

Patient Populations and Reimbursement: How well do you understand your patient population? Does it play a role in your coding? It should, because it means revenue for your practice. The Affordable Care Act’s risk adjustment program for exchange plans moves money from insurers with healthier patient populations to those with less healthy populations. Now more than ever, your staff needs to understand risk adjustment methodologies and patient risk scores. Your staff needs to know that those risk scores will determine whether you receive more money, less money, or even have to return money to your contracted payers.

Your medical practice needs a regular check–up just like your patients do. Keeping your finger on the pulse of your business and the impact of regulatory changes can increase your medical practice revenue. MICI stands ready to work for you, strengthening your practice and educating your staff. Call us, let’s talk about how we can help you successfully meet these significant changes head on.


* iHealthBeat report.