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The Healthcare reform is pushing healthcare organizations to follow a more quality based reimbursement model vs. quantity based. It’s imperative that being in the business of serving patients, the quality of care carries supreme importance. While every center wants to provide quality services, there are aspects by which quality may sometimes be compromised – increasing patient volume, lack of resources, the time spent behind each patient visit. It’s the need of the hour for centers to do things differently and here are some thoughts.
Last year, I went to Trincomalee on the east coast of Sri Lanka to volunteer at Grace Care Center, a wonderful orphanage and center for elders run by a friend and colleague Naresh Gunaratnam, MD from Ann Arbor, Michigan. I was part of a small group – we were mostly alumni from University of Michigan (from medicine, law, finance and business backgrounds) and one from Texas. Naresh suggested that we experiment with remote healthcare delivery/ management by rolling out enki EHR at the Center.
My dad frequently forwards some amusing emails. Today I got an email about a group of frogs that were given the challenge of climbing a mountain. Once they started climbing, several of them started realizing how difficult the task was. Some got scared.
Before considering this question, let’s recap the process before it’s time to send patients a financial statement for the amount that is her responsibility. A patient is responsible for a service usually when her insurance pays nothing or a portion of the fees. Before a visit or a procedure, it’s imperative to check a patient’s eligibility and benefits. We find several practices/ surgery centers that do not have the bandwidth to complete this task and the practice management system is not equipped to complete this task automatically.
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.
They are the scrutinizers. The claim sniffers. They are the auditors. Have you ever thought of why your claims are denied or paid? Is there a really smart computer or a human face behind that hits to go or the no-go button? It’s both. When you submit claims, they go through some really intelligent computer programs. These programs process each claim and flag irregularities. These red flags are then extensively analyzed by claim auditors.
Statistics show that over 50 percent of all medical facilities have successfully transitioned towards implementing an electronic health record system. While implementing EHR may mean streamlining operations and going paperless, the process tends to become mechanical and many look at it as mere data entry over time.
Want to fast track your reimbursement cycle? Different insurances differ in the time they take to process claims. Target easier insurance carriers with specific focus and see the change. One carrier which centers should look at is Medicare. It has a straightforward submission process coupled with fewer hassles for reconciling denials.
A claim can be denied even before a patient is seen by the physician. Essentially, the revenue cycle begins when a patient calls in to schedule an appointment. As simple as it may sound, the primary cause of most pre-visit denials is the lack of a checklist. What we don’t find in centers after centers, is the execution of the following list before every patient visit: