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Good Billing Is Just Process Great Book is Check List Manifesto by Atul Gawande, MD. Good Billing is Like Good Surgery or Any Activity in Life that Requires.

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Presentation on theme: "Good Billing Is Just Process Great Book is Check List Manifesto by Atul Gawande, MD. Good Billing is Like Good Surgery or Any Activity in Life that Requires."— Presentation transcript:

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2 Good Billing Is Just Process Great Book is Check List Manifesto by Atul Gawande, MD. Good Billing is Like Good Surgery or Any Activity in Life that Requires Organization! Life and Billing is Complicated but Steps in an Organized Manner Make it Easy. Someone Asked Why We Keep Track of All Scheduled Patients.

3 Create an easily accessed, integrated, web-based EHR system specifically designed to address the needs of your practice and the demands of the practitioner. Use technology to develop an electronic “medical home”. Reduce errors. Improve quality and safety. Increase revenue. Create performance measurement tools. Increase patient education. Enhance communication among service providers. Commercial Billing vendors. Try and meet all of these complex needs in one, comprehensive EHR solution and avoid the excess cost and lack of continuity associated with multiple technology Create a Process

4 The Dilemma Patient Scheduling Patient Demo Entry & Eligibility Verification Medical Necessity Edits Claims Scrubbing Paper & Electronic Remittance Denied Claims Compliance System Claims Management EMR/EHR Registration System Distributed environment lead towards inefficient, complex system results in increased operating cost and important of all LOST REVENUE

5 The Revenue Cycle: Critical Billing Tasks

6 CureMD - Integrated All-in-One Solution CureMD EMR PMS & RCM Registration & Scheduling Clean Claim & medical necessity Edits Denial Management Patient Scheduling Patient demo entry & Eligibility Verification Patient demo entry & Eligibility Verification Medical Necessity Edits Medical Necessity Edits Claims scrubbing Paper & Electronic Remittance Paper & Electronic Remittance Denied Claims

7 What makes us stand apart in billing? One system that ensures integrated clinical and improved communication for the complete revenue cycle management. All in one solution that works with your existing billing and financial system ensuring: i.HIPAA Compliance ii.Efficiency improvement iii.Maximum effectiveness iv.Ensuring clean claims for denials prevention v.State of the art rejection and denial management vi.Reports that make sense and Monitor activity.

8 Poor Revenue Cycle Management More Income is Lost in Poor RCM Than You Can Achieve in Rate Increases

9 Why Outsource Billing? Straight 60 % reductions in operational and administrative cost in comparison to in-house billing Staying up to date with financial health of your practice by having access to multiple financial reports (24/7) in comparison to manual in- house reporting Losing 2% of total Medicare revenue on e-prescribing and PQRS incentives Losing 17% of all claims denied for timely filing, caused by delays in the billing (Source AMA) Efficient Denial Management enables you to track denied claims and what is being or can be done to get them paid. (MGMA reports that 7%-14% of all claims are denied because of easily correctable in– office errors)

10 It’s More Than Just Time You still need to document the visit! Does you System Check Codes or Prompt Needed Items. Codes should be used depending on the complexity of the visit For level 5 make sure the history meets the definition of comprehensive. A new patient is a patient who has not received any professional services (face to face) in the last three years. This time includes those you see for a different Dx.

11 What is a Medicare Consult? “conventional medical practice is physicians making a referral and physicians accepting a referral will document the request in the patients record”. The results of the referral must be communicated. For in hospital cases the principle physician of record will append modifier “AI” on codes. Coordinate with Hospitalist! If physician is requested to see a patient in the ED, the emergency visit code should be used unless patient is admitted and then initial hospital care code should be used.

12 How do you Bill? If the service is secondary to a primary service must use modifier 25 on the primary service. Smoking cessation requires a separate diagnosis code as does nutritional counseling. You don’t have to be a PCP but annual visits are limited by type, smoking for example is 8. Make sure you are familiar with the coding instructions and as a guideline CMS for the first time has published time indicators. For example: 99213=15 minutes, 99214=25, =40 minutes, = 45 minutes. Don’t forget the “AI” for your admitted patients.

13 Make Sure to Use the Right Codes Manhattan Allowable Initial Wellness = G0402$169 EKG’s (no waiver) G0403-G0405 (G0403 price)$24 Annual Wellness = G0438 & G0439$186 & $125 Ultrasound for aneurysm = G0389$137 Medical Nutritional Therapy = $34 & $30 Medical Nutritional Therapy Group = $28 Medical Nutrition Therapy Additional = G0270 $32 Medical Nutrition Therapy add on Group = G0271 $16 Screening Pelvic Exam = G0101 $43

14 Financial Reports CureMD’s 24/7 access to different reports helps to stay updated with your practices financial health

15 Some Numbers That Matter!

16 CureMD Healthcare 55 Broad Street, New York, NY Ph: Thank you


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