On July 8 2015, CMS released the 2016 Medicare Physician Fee Schedule proposed rule which, if finalized, would drastically cut reimbursement rates for colonoscopy and other lower GI endoscopy procedures. Can your afford such cuts? Whether or no1t the proposed reimbursement cuts take effect, gearing up for the worst case scenario is the best way going forward.
Here are three tips that will help your practice plan better should the cuts be implemented (or not):
1. Same day claim submission: Many ambulatory surgery centers and specialty practices have specific days in a week when claim submissions happen. This results in an overwhelming number of claims pending to be submitted. To catch up with the piling claims, practices often resort to a rush job with lack of quality checks, not following billing guidelines, resulting in a growing number of denials. As a result, they face uncertain reimbursement patterns. Set an internal benchmark of clearing claims within 24 – 48 hours of the date of service.
2. 90+AR at 5%: Accounts receivables is mostly where the money lies. As with same day claim submission, also resort to same day denial management. Take relevant action on denials as soon as they occur. This is your best bet to get accounts receivables under control. Aim for 90+ AR to be at 5% to avoid reimbursement disruption.
3. Accurate medical documentation: At the onset of reimbursement cuts, it becomes extremely crucial that each claim be processed and paid accurately. On many occasions insurance companies ask for supplementary medical documentation prior to processing the claims. Adopt case specific documentation methods vs. templated approach. The benefits are twofold – the turnaround time for such claims to get paid is relatively less (as there is no back and forth with the carriers on missing/incorrect documentation) and it establishes your practice as a place for getting patient centric medical care.
The above tips can help optimize operations irrespective of reimbursement cuts. Not only does the payment cycle becomes more predictable, but also, provides clarity on the overall health of the practice. Have suggestions of your own? Let us know in the comments below.
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