Aug 21, 2014 | Uncategorized
Z02.0 — Encounter for examination for admission to educational institutionnnZ55.3 — Underachievement in schoolnnY92.157 — Garden or yard of reform school as the place of occurrence of the external causennY99.8 — Student activity as the external cause statusnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Aug 21, 2014 | Uncategorized
Cash flow is often the difference between keeping a private practice private and looking for an alternative situation that may not be quite as palatable to the doctors.
nTo us, Cash Flow is not just important… it is EVERYTHING. The staff and management of AMRS work very hard to generate regular, predictable cash flow including working with the practice staff to get the right information at the right time to the payers so they will be able to pay the claim quickly. Clean claims are the goal and we will do what is necessary to get a clean claim to the payer quick! Working with your staff to explain, coach and even prod to get the right information out the door fast. Billing is easy! Getting the right information to the right place is hard for some practices (maybe they have training issues or a lot of staff turnover or a thin labor pool), it is something we pride ourselves in.n
Q: You make it sound so easy, why do so may have problems with cash flow?
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A: It is often attention to detail and a training issue. Staff turnover causes disruption and “brain drain.” The Revenue Cycle requires constant attention, like riding a bike. It is easy but it has to be done right and constantly for the results to be good. Think of all the muscles, tendons, bones, joints and nerves working together to ride a bike, balance, eye sight, awareness and anticipation. Seems so easy when it is going well. When you have a broken leg or have lost your balance it then becomes incredibly difficult. Just one component not working well with all the others will make you crash your bike or crash your cash flow!
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Q: Everyone wants to be paid, why is Cash Flow itself so important?
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A: Cash Flow is everything in a service business. Cash Flow is the life blood of every service business. There are salaries and rent to pay whether one patient is seen or one hundred. The constant and predictable flow of reimbursement is critical.
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Q: Doctors (and other medical professionals) work as hard now as they always have (in some cases more so) but taking home less money. How can AMRS make a difference?
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A: Fee-for-service revenue, for procedures (what used to be the big ticket items), is under constant downward pressure. Some services are paid more and a lot are constantly being paid less. A good billing service understands this and works to help their customers to also understand it. At AMRS we not only bill and collect, we analyze billings and collections to help the providers maximize their revenue where ever possible. We are ready and able to work with and help our clients with other reimbursement methods. We are not only knowledgeable, we are excited to work with Capitation, Bundled payments, Risk adjusting and others. n
Aug 5, 2014 | Uncategorized
L75.0 – Bromhidrosis (Body Odor)nnL75.1 – Chromhidrosis (Colored Sweat)nnR61 – Excessive SweatingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Aug 5, 2014 | Uncategorized
The Centers for Medicare and Medicaid Services (CMS) has issued its final rule officially setting the ICD-10 transition date for October 1, 2015. Asserting that the new date “allows ample time” for the healthcare industry to prepare for the change, the final rule confirms what the agency told the industry in May after the one-year delay was voted through as part of the Protecting Access to Medicare Act of 2014.n
“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of CMS in a press release announcing the finalization. “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”
nAfter being blindsided by the unanticipated delay, CMS has only provided sporadic updates to the industry as it reworked its timelines, testing, and transition plans. Earlier in July, six Congressional leaders asked Tavenner for details about any newly laid plans for the conversion even as healthcare providers have been largely forging ahead with education and technical activities on their own.nnThe final rule has been published in the Federal Register and is available in full here.nnSource: www.ehrintelligence.com; Jennifer Bresnick; July 31, 2014.
Jul 22, 2014 | Uncategorized
“Eligibility” is not what it once was! Commercial health plans have HMO’s and PPO’s and various other plan types, they also have various products within those categories, and just to make it more complicated some plans have plans within the plan specific to a given employer or group’s requirement. The Affordable Care Act has added to this confusion by adding more plan types, and those plans have various benefit calculations and yes, provider networks.nnEven Medicare and Medicaid have plans within plans. A patient who presents with “Medicare” could have straight/traditional Medicare but they could also have a Medicare Advantage plan with a specific network. Medicaid now has commercial carriers and many have very specific networks of providers, and patients can move in and out of these plans frequently. All of these changes are designed to help control costs and direct patients to the right place.nn(It’s not all bad thing – there is opportunity here – see below.)n
Performing patient eligibility checks, in real time, is more important than ever:
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- Does the patient have the insurance they think they have?
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- Do they have the coverage they think they have?
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- Are they seeking care from the right provider?
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- Is your provider/practice in-network with the patient’s insurance?
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- Is the patient on an exchange plan? Have they paid their premiums (to ensure your provider will be paid for the services they provide)?
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- What is the patient’s co-pay, deductible and co-insurance, and what have they already met?
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nThe good news: Most of this can now be automated! Many of the good clearinghouses have a component that checks patient eligibility. Most can be done in real-time with up to the minute check of benefits and participation in a specific plan. Most can also check to see if your specific services are in-network, allowed and payable. This can now be done with the click of (a few) key strokes and fast internet connectivity.nnIt takes good and conscientious staff, constant training of your staff (to stay on top of changes), and the re-design of some work flows and seamless systems that talk to each other. The other great thing about clearinghouses is that they report mistakes – those reports just have to be read, analyzed and used as a tool for process improvement.n
Opportunities:
nWith such sophisticated systems out there, practices now have the opportunity to collect for services up front (if deductibles and co-insurance are not met) instead of tracking down payment from the patient afterwards. This will result in increased revenue and cash flow for the practice! Dentist offices have done this forever – it is time for medical practices to do the same!nnHealth plans and payers of all sorts are looking for those who can be and are willing to be “Eligible” to provide cost effective care. It may not be reimbursed in the traditional fee-for-service method but these niche opportunities do exist!
Jul 22, 2014 | Uncategorized
L55.0 — First degree sunburnnnL55.1 — Second degree sunburnnnL55.2 — Third degree sunburnnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
