Tag: RCM

16 Apr 2016

Your Medicare billing is now public through Treatment Tracker

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Treatment Tracker, a tool released by ProPublica (an independent, investigative, non-profit newsroom), now reveals how doctors in the country (any doctor) coded for the 46 million Medicare patients in 2012. Medicare paid for more than 200 million office visits in that year and now that data is available for all to see. It provides amazing insight – for example, 1,800 providers billed high codes 90% of the time, bringing into a unique form of public scrutiny.

The tool allows you to drill down by each physician and provides her rank within a state and specialty, the number of services she has performed, total and average payments by Medicare and how she has coded overall. It further provides information about each of the procedures billed to Medicare, # of unique visits by patients on whom the procedure was performed and so on.

What physicians who are letting their EHRs code for them are not realizing is this: by allowing the system to suggest codes (often higher codes) based on clicks over Physical Exam, Review of Systems and templatized SOAP and operative notes, they would need to be prepared to future public scrutiny that would peg them with peers across their county, state and the whole country. Imagine this in the context of ALL the data provided to CMS via Meaningful Use.

Welcome to the world of big and open data!

09 Apr 2016

Focus and cut costs to thrive in Ambulatory Surgery Center market

Focus and cut costs

Since 2010, the ambulatory surgery center (ASCs) market has neither grown nor declined. ASCs start, shut-down and acquire other ASCs. There are over 5,400 surgery centers. Available physicians are limited and hospitals continue to pose a strong competition – sometimes partnering with ASCs. According to arecent Becker’s ASC article, ASCs will need to excel in a single specialty and run a very low cost center model to sustain in the future.

Focus

There are three dominant specialties in the ASC market: orthopedics, gastroenterology and ophthalmology. Let’s the example of ASC centers focused on gastroenterology. As medical science advances and a greater number of newer procedures become eligible for insurance reimbursement, gastroenterologists must develop deeper focus within the specialty. In 2014, there are 26 new codes for gastroenterology – suggesting newer ways to focus, get reimbursed and build expertise. A group must focus on EUS, another on EGD or esophagoscopy and so on. This method of divide and conquer would allow an ASC to be known as a leader in the field within their market and at the same time cover a wide range of procedures within the specialty.

ASCs can further add plans that involve diet and exercise, virtual follow-ups for a monthly fee. This creates additional revenue streams based on deeper understanding of patients and their conditions. It also engages patients and their families better and brings them back to the center on a regular basis.

Cut costs

Outsourcing activities or tasks in a controlled and methodical manner is clearly a way to bring costs of administrative tasks down. Identify tasks that are lower on the complexity scale and delegate and outsource them. When they aren’t core to the business model (i.e., treating patients), tasks such as billing, coding, denial management, patient collections, accounting, credentialing, pre-authorizations and so on will tend to be distractions from the core focus of the surgery center. Outsourcing companies centralize operations for a large number of providers, giving them benefits of scale – these cost savings are typically passed on to the center that could then pass them on to patients.

According to the ASC Value Driver Survey, 24% of ASCs experience stable volume, 27% reported growing volume and 27 percent declining volume. In the same survey, respondents cited competition from other ASCs and hospitals as one of their biggest challenges. Clearly, it’s a time to focus and cut costs to stay competitive.

09 Apr 2016

5 Things to look for when reviewing billing of a surgery center

When I review billing of an ambulatory surgery center, here’s what I mainly look for and it usually gives me enough clues to what I need to know.

1) Are there unbilled charges from more than a month ago?

2) How many denials show up in the EOBs received from Medicare and BlueCross for the previous week? I tend to review ALL the EOBs.

3) What’s the comparison of new patients to existing patients over the past year? What types of insurances do they represent?

4) How does the Accounts Receivable Master look? How many high-dollar claims (e.g. above $1,000) are untouched – over 90 days, 120 days and so on?

5) When were the contracts last updated?

There are several other things that I could look for and I do but at the outset am looking for a feel of how a center is doing. Answering these five questions usually provides me with a direction to probe more. I supplement these with interviews with staff. Another important activity that I do is to simply sit by the front desk and observe patient flow and work flow through the day – sometimes for several minutes at a stretch.

Taking the above steps, we turned around a gastroenterology center at one of the major hospitals in New York.

By Praveen Suthrum, President & Co-Founder, NextServices.
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