If you accept workers' compensation patients at your practice, it's a good idea to review the contracts for some of the finer details of how you will be paid. There are a few areas that you can look at today that will help you be paid tomorrow:
• State where the workers' compensation plan originated from. Believe it or not, different states use different codes. If you are seeing a patient for an extended visit and often code the same you would a patient that has Medicare for the same visit, you may not be getting paid. This can also be said that if you are coding for multiple workers' compensation patients, and one is an out of state plan, you may be paid for one and not the other using the same code. Investigate those adjustments to make sure this is not the case. You can find the codes you should be using in your contract, or at worst, you can call another physicians office in the state the plan originates from and ask them what code they use.
• What codes are actually paid by workers' compensation. Some workers' compensation plans will pay for a specific treatment, and others will not. It's important to track these items so you are aware of what will and won't pay. Otherwise, you are giving away care and losing a lot of money in the process.
• Oftentimes whether or not you are paid will simply rely on what is on the authorization form that came from the nurse case manager or adjuster. If there is something you'd like to do, and do not see it on the authorization, chances are you won't be paid for it on that appointment. Best to have your front-desk staff call and obtain authorization for the treatment you wish to perform. Sometimes you can get this authorization in as little as a few days up to several weeks, so plan accordingly.
• Are you contracted with Medrisk, but not Universal Smart Comp? If Universal Smart Comp is the actual payer on the claim, you won't be paid. I know this seems confusing, but when your staff verifies the insurance and contacts the adjuster, it's best to ask, "Who is the payer?" If it is a company you are not contracted with, you can request another payer whom you are contracted with.
Regardless of the reason for a denial, it is so important to really know and understand your contracts. There may be tips and ideas for getting paid that adjusters are not willing to share after-the-fact once the denial has happened. Many are not very helpful or are just plain hard to get a hold of.
With the changes coming over the next several months, I've found that workers' compensation groups are buying each other up, merging or partnering strategically like the big payers (Wellpoint with Blue Cross and Amerigroup, Aetna, and Coventry, etc.) this may bring many changes to the workers' compensation reimbursement structure.
As always, know your payer mix, know why your adjustments are as high as they are, and read your contracts closely.
By P.j. Cloud-moulds Courtesy of: Physicians Practice http://www.physicianspractice.com/blog/workers-compensation-plans-getting-patient-claims-paid?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=15102013
Showing posts with label contract. Show all posts
Showing posts with label contract. Show all posts
Thursday, October 17, 2013
Wednesday, October 2, 2013
Patient Out-of-Pocket Expenses Rise, Squeezing Physician Cash Flow
Maintaining cash flow is a growing challenge for physician practices now that their "bread and butter" privately insured patients are paying more and more of their healthcare expenses out of pocket, and it will get worse.
Out-of-pocket expenses not including premiums have increased to an average $768 for each privately insured consumer in 2012 according to the nonprofit, non-partisan Health Care Cost Institute, and are projected to skyrocket as much as 50 percent in 2015 under Obamacare’s numerous mandates.
Maintaining your practice’s cash flow requires much more than initiating more aggressive patient obligation collections policies. Payer contracting, practice marketing, and patient-service strategies must change to keep pace.
Payer Contracting
The market will soon be flooded with newly insured and reinsured through exchanges, mostly women because newly mandated coverage favors women and relies on men to share the cost. Employers will be re-evaluating policies and, if they keep insurance at all, will be gravitating to higher-deductible policies to keep pace with subsidized premiums.
Identifying major area employers with whom they insure, and whether or not they have high-deductible policies, is a new must. It isn’t just how much the insurer pays you anymore, it is how much the employee must pay you as well. Upscale employers typically have upscale insurance with higher reimbursements, lower co-pays and deductibles, and employees who can afford to pay them. As obvious as focusing on them as this may seem, going in-network with these payers and competing for their members has not dawned on most, if any, practices as a strategy.
Practice Marketing
Identifying and stratifying the best-insured employees and their families is a key competitive and marketing strategy. Getting those patients established with your practice is goal number one. Strategically, getting in network and understanding their needs is a must. Tactically, your marketing should be keyed to them. Your message should resonate with them. Your practice services should cater to their needs. And, you should be using experienced professionals for research, branding, messaging, and marketing.
Patient Services
Doing things right to gain a competitive advantage requires an investment in time and money. Keeping patients does not. It requires something else except in rare cases: a change in practice culture.
With all of the focus on patient-centered care, there is almost none on patient-centered services despite reams of literature showing that satisfied patients feel better, do better, and bring their friends and family along with them.
Change begins at the front desk with two very simple things: welcoming people and having an experienced staffer answer phones. How patients are treated sets the tone for the rest of the visit and determines the “patient experience,” and it all rests on office culture: Does your practice accept patients, or welcome them?
It all circles back to the beginning with two straightforward quirks of human nature: Happy patients are most likely to pay their bills while unhappy patients are most likely to sue.
For good advice on how to provide excellent customer service, click here.
Out-of-pocket expenses not including premiums have increased to an average $768 for each privately insured consumer in 2012 according to the nonprofit, non-partisan Health Care Cost Institute, and are projected to skyrocket as much as 50 percent in 2015 under Obamacare’s numerous mandates.
Maintaining your practice’s cash flow requires much more than initiating more aggressive patient obligation collections policies. Payer contracting, practice marketing, and patient-service strategies must change to keep pace.
Payer Contracting
The market will soon be flooded with newly insured and reinsured through exchanges, mostly women because newly mandated coverage favors women and relies on men to share the cost. Employers will be re-evaluating policies and, if they keep insurance at all, will be gravitating to higher-deductible policies to keep pace with subsidized premiums.
Identifying major area employers with whom they insure, and whether or not they have high-deductible policies, is a new must. It isn’t just how much the insurer pays you anymore, it is how much the employee must pay you as well. Upscale employers typically have upscale insurance with higher reimbursements, lower co-pays and deductibles, and employees who can afford to pay them. As obvious as focusing on them as this may seem, going in-network with these payers and competing for their members has not dawned on most, if any, practices as a strategy.
Practice Marketing
Identifying and stratifying the best-insured employees and their families is a key competitive and marketing strategy. Getting those patients established with your practice is goal number one. Strategically, getting in network and understanding their needs is a must. Tactically, your marketing should be keyed to them. Your message should resonate with them. Your practice services should cater to their needs. And, you should be using experienced professionals for research, branding, messaging, and marketing.
Patient Services
Doing things right to gain a competitive advantage requires an investment in time and money. Keeping patients does not. It requires something else except in rare cases: a change in practice culture.
With all of the focus on patient-centered care, there is almost none on patient-centered services despite reams of literature showing that satisfied patients feel better, do better, and bring their friends and family along with them.
Change begins at the front desk with two very simple things: welcoming people and having an experienced staffer answer phones. How patients are treated sets the tone for the rest of the visit and determines the “patient experience,” and it all rests on office culture: Does your practice accept patients, or welcome them?
It all circles back to the beginning with two straightforward quirks of human nature: Happy patients are most likely to pay their bills while unhappy patients are most likely to sue.
For good advice on how to provide excellent customer service, click here.
Wednesday, July 17, 2013
Palmetto Jurisdiction 1 Part B NOTICE OF NEW INTEREST RATE FOR MEDICARE OVERPAYMENTS AND UNDERPAYMENTS
Jurisdiction 1 Part B
NOTICE OF NEW INTEREST RATE FOR MEDICARE OVERPAYMENTS AND UNDERPAYMENTS
Medicare Regulation 42 CFR §405.378 provides for the assessment of interest at the higher of the current value of funds rate (one percent for calendar year 2013) or the private consumer rate as fixed by the Department of the Treasury. The Department of the Treasury has notified the Department of Health and Human Services that the private consumer rate has been changed to 10.375 percent effective July 17, 2013, for Medicare overpayments and underpayments.
Source: Change Request 8415
Thursday, July 11, 2013
Do you want to be successfully self
employed? Do you want to work from home?
Then you may want to start a career in medical billing. It’s certainly not a get rich quick scheme. You have a lot of learning ahead of you. But once you put in the time and effort to learn and get started you will find medical billing to be a very economical and rewarding career.
The world of medical billing is an ever changing one. Policies and procedures are constantly being updated. In this book I will teach you how to stay on top of them. Medical providers and their staff do not have the time or resources to keep up with insurance companies and their seemingly constant policy changes. Many medical providers outsource to professional medical billing services, like the one I will teach you to be.
This book will take you step by step to start your medical billing service. Including all the tools you need to get started, how to market a provider, writing a professional contract, determining your fees, and choosing software. I also share my secrets of medical insurance companies and patient collections with you. Throughout the book I discuss additional services you can offer to generate even more income for your medical billing service.
https://www.createspace.com/3977179
Then you may want to start a career in medical billing. It’s certainly not a get rich quick scheme. You have a lot of learning ahead of you. But once you put in the time and effort to learn and get started you will find medical billing to be a very economical and rewarding career.
The world of medical billing is an ever changing one. Policies and procedures are constantly being updated. In this book I will teach you how to stay on top of them. Medical providers and their staff do not have the time or resources to keep up with insurance companies and their seemingly constant policy changes. Many medical providers outsource to professional medical billing services, like the one I will teach you to be.
This book will take you step by step to start your medical billing service. Including all the tools you need to get started, how to market a provider, writing a professional contract, determining your fees, and choosing software. I also share my secrets of medical insurance companies and patient collections with you. Throughout the book I discuss additional services you can offer to generate even more income for your medical billing service.
https://www.createspace.com/3977179
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