A Brave New World: 6 Steps to Prepare Your Practice for a New Reality
You know the reality: COVID-19 is here to stay for now. The goal facing us all now is how to move forward, and your practice is no different. Even with the risk of the virus, the world, and your practice, must be prepared to face a new reality.
How can you do this successfully?
You need to develop a strategy that prepares yourself and your practice for the challenges to come.
Let’s examine the six steps to get this done:
Focus on Patient Safety - Your patients are the lifeblood of your practice. Your number one priority is to ensure they stay, and feel, safe when visiting your office. Following federal guidelines on preparing your practice is one of the best ways to achieve safety.
You also must communicate your safety practices with your patients. Post signs, spread the message across your marketing channels, and make sure your employees know everything you are doing to keep your patients healthy so they understand, follow through, and can answer questions.
Keep Your Staff Healthy - Speaking of your employees, you must make sure they feel safe and secure working in your office as well. Not only do you need to keep them safe for their good, but if the front desk receptionist or the tech taking vitals show signs of nervousness, your patients may feel uneasy about coming back to your practice. Worse, they can spread the message that your practice is not where people should go.
Put your staff at ease by letting them know the practices and policies you are implementing to keep everyone safe. Create an environment of communication where everyone feels comfortable expressing concerns to you or other members of your management team. Allow your staff to share potentially helpful tips or information.
Telehealth is Here to Stay - You hate to declare someone or something a “winner” during a pandemic that has (at the date of publication) claimed over 100,000 American lives. That said, with regard to the medical industry, telehealth has come out ahead during the COVID-19 crisis. In 2019, only 11% of Americans used telehealth. During the pandemic, that number has jumped to 46%. An easing of regulations allowed providers to use telemedicine areas not previously available.
While it is likely that we will see at least a small retightening of restrictions as the country opens up, they will NOT go back to pre-COVID-19 levels. The genie is out of the bottle, and preparing your practice to handle more telehealth visits is vital. You have to think, on an operations level, how to handle an increase in these types of visits.
Coding and Billing - We broke this down into two parts: general coding and billing and COVID-19 coding and billing. Let’s look at them individually:
- General - Your coding and billing procedures have always been important. Now, as your office tries to get back on its feet, how and when you get paid for services rendered becomes even more important. You cannot wait for weeks or even months to get paid, and you probably will not have the time it takes to resubmit claims. Take some time to review how often claims were denied before the pandemic so you can root out the cause. Look into your prior authorizations. Work with your coding and billing team to try to make this process as streamlined as possible.
- COVID-19 - If you are providing any services related to COVID-19, you must understand how to submit claims correctly. CMS has released guidelines for this. We suggest that you search for and study these guidelines so your knowledge and practices are up-to-date.
Rethink the Patient Experience - We touched on an aspect of the patient experience with safety. But as important as safety is, it does not encompass the entirety of the issue. Create the best possible experience for your patients by rethinking the experience you want your patients to have.
Your patients may be more nervous than usual, or even scared. Part of your job as a healthcare provider is to ease those concerns as much as you can. For your practice, this could look like funneling people towards telehealth so they do not have to visit your office in person. For those who need an in-office visit, make sure your staff understands their expectations in terms of the healthcare they are receiving.
Remain Flexible - This pandemic is an evolving situation, which means things like regulations, patient expectations, people’s attitudes, etc. are likely to change. Remain flexible so your practice is able to respond quickly to changes on the ground. Set the tone with your staff by keeping a positive attitude and asking them to help you keep on-top of the current and future needs and demands of the field.
The COVID-19 pandemic has ushered in a brave new world. For your practice to succeed in this current reality, you must prepare yourself by thinking strategically.
How Telemedicine Will Impact Your Practice
The medical industry is in a perpetual state of evolution. Why? It’s an industry that must continuously evolve to answer the demands and challenges that come with new technologies.
In the 90s, the advent of the Internet introduced a way for providers and patients to be able to communicate more efficiently, especially across long distances. However, with that came concerns about security, patients’ privacy, and misinformation surrounding medicine and medical conditions. The industry has had to develop systems and policies to address these concerns.
The same is happening now with a new technology that similarly could impact healthcare in a similar way as the internet: telemedicine.
Telemedicine is “the remote delivery of healthcare services.” Although telemedicine has technically been around since the late 1950s, the Internet, combined with video streaming platforms like Skype and Facetime, allows doctors and patients to “meet” virtually across pretty much any distance.
Telemedicine is making healthcare more accessible and cost-effective, and it’s increasing patient engagement. However, just like the advent of the Internet, telemedicine is introducing some new challenges and concerns for healthcare providers.
Let’s examine a few:
- Know The Rules and Regulations - Before you decide to take on telemedicine as part of your practice’s offerings, make sure you understand state and federal rules and regulations. You must also keep in mind that, as with most new technologies, regulation is usually a few steps behind. This means if you do take on telemedicine services, you must be diligent and stay current on any changes that could impact what you are doing.
- No Standard Set of Rules - Another regulation-related concern associated with new technologies is it takes time for a standard set of laws to be written and adopted. This is particularly evident on the state level. What is right for your state may not be correct for a potential patient in another state. Make sure you understand not only your state’s laws that apply to your practice but to the laws that apply to your patients’ states as well.
- Be Mindful of HIPAA - HIPAA regulations still apply to telemedicine patients. Review your current internal processes relating to HIPAA to ensure you are following everything you should, and then apply those processes to your telemedicine efforts.
- Data Management and Security - Conducting medical appointments online will open you up to hackers and other people intent on accessing your patient’s data and your data. Before taking on any telemedicine patients, review your security measures, and make sure your data is stored correctly and securely.
- Internal Processes - Taking on telemedicine will be a significant change for many practices. Prepare your practice by speaking with your office manager, any physicians who intend to take telemedicine patients, and any key personnel to ensure everyone understands the policies and procedures you need to follow. Draft a set of guidelines and distribute them amongst your staff so everyone is on the same page.
- Must-Have Insurance Contracts - Before you take on any telemedicine patients, make sure you speak with the insurance companies to get the contracts you need to have the telemedicine visits covered.
- Codes Will Change - A virtual visit is not the same as an in-person visit. We understand that you know this, but this means that the coding for telemedicine patients will be different. Make sure whoever does your billing and coding understands this and is aware of the codes they need to use.
Telemedicine presents an excellent opportunity for healthcare providers to help more patients and grow their practices. However, if you are not careful, you can end up causing some major short- and long-term problems for your practice AND patients. Before you get started, make sure you have all your bases covered and prepare your practice to take on this new challenge.
As always, if you need help with the coding, billing, or contract part of the process, please let us know!
Three Signs You Need Coding Help
One of the most critical components of operating a successful medical practice is correct medical coding. Improper coding can result in the loss of revenue and have legal and financial consequences for a medical practice.
Mednet focuses on assuring that our clients bill for and get paid for every dollar they are entitled. We stay focused on the financial aspects of proper coding so you can focus on your patients.
But how do you know when your practice needs help coding? Here are three signs:
Reimbursements are Less than They Should Be
As a doctor, you know how many patients you see each day and the services you provide. While you may not be able to guess the exact amount of revenue you’re bringing in, you have a general idea.
Common coding errors, like missing information or incorrect procedure codes, may result in a lack of payment to your practice. You may also be failing to recognize a billing opportunity, which can also affect the revenue you earn.
Have ever reviewed your monthly or quarterly numbers and thought, “Wow, I thought the revenue for this last period would be higher?” You may want to trust your gut and review your coding procedures to ensure that you are collecting the correct amount on every service you provide.
Payments Are Delayed, Reduced, or Do Not Occur
This next sign is often the main culprit of loss of revenue. When you submit claims with incorrect coding, payment for those services is most likely going to be delayed or reduced, if they happen at all.
Insurance companies wil not pay for services that are not covered in their contract. And it is always difficult to collect from patients who thought their insurance covered a service provided by your practice.
This is why proper coding is so necessary to your revenue cycle. You want to correctly document services rendered for the patient so that insurance companies reimburse you in full for everything that you do.
Productivity of Entire Practice is Lessened
This last sign may very well be the most insidious because it is the hardest one to recognize. If insurance companies are denying claims because of improper coding, then you will have to have someone on your staff rework that claim. But there is an opportunity cost to this. For every claim you have to revise, there is a task that may be delayed or not done at all.
A lot goes into operating a successful practice. If you spend too much time redoing work that should have been done the first time correctly, you are losing out on ways to improve how your practice operates.
These are no easy metric to recognize or quantify, so it may be weeks or even months before you understand why your practice is not operating as smoothly as it should. This is another “trust your gut” situation. If there are projects or tasks not being completed, or if you recognize one or both of the first two signs, then chances the overall productivity and revenue of your practice is suffering.
Incoming revenue is the lifeblood of your practice. You need it to pay your staff, for the office, for supplies, and everything else that goes into operating your practice. To keep the revenue flowing at the maximum level, you need to ensure your coding is correct.
If you see any of the signs listed above, then you must investigate, or you can risk the long-term success of your practice.
How to Find Success in 2020
A new year, and a new decade, is upon us. This time of year presents an excellent opportunity for reflection and looking back at our successes so we can take a moment to appreciate them. It’s also a time to take a look at our shortcomings, so we can learn and grow from them.
And we can use these lessons from the past and apply them to the new year to see how we find success. We want to assist you in this by looking at which billing and operational trends you can look forward to so you can plan for a more successful 2020.
Medical Billing and Coding Trends
If the physicians and the staff are the engines that keep your practice going, then it is safe to say that the billing and coding is the fuel. After all, if you don’t get paid for your services, your practice won’t be around for too long. The following trends utilize technology with one goal in mind: make the process of getting paid more accessible and more efficient.
- Cloud-Based Medical Billing Software - The “cloud” has become a popular mechanism for many industries. For medicine, it remains a bit controversial due to concerns with security. It is safe to assume that companies are taking significant measures to make the cloud a more secure option for medical billing. As this happens, you can count on the cloud becoming a more attractive option for practices needing to access their patient info on the go.
- Electronic Claims Processing - This is not a new trend as the software for processing claims electronically has been around for quite some time. However, in the coming year and beyond, the software developers will improve the capability of their programs. This will open the door for automated billing options that are more useful and easier to operate.
- Computer-Assisted Coding - Designed to make the coding process more efficient, Computer-assisted coding, or CAC, helps determine which codes might be needed and highlight any errors. As with any new technological development, when first introduced, there was skepticism around CAC. Like other technological developments, it is more widely used now that the technology has improved (and will continue to do so).
The big takeaway for billing trends is to keep an eye out for how technology is impacting the process of submitting claims and getting paid. Chances are there is something in development that can help address a problem you are experiencing. As always, you can contact us with any questions you may have.
Many things can impact how well your practice runs on a day-to-day basis. Let’s look at a couple of trends that might help your practice run a little smoother:
- Outsourcing RCM Services - In 2019, a record number of practices outsourced their revenue cycle management (RCM) services. The trends mentioned above take time and effort to learn and monitor. And if you choose to implement a change, that is time, money, and effort that you have to invest in making the change. It may be more cost-effective to outsource your RCM services so you can focus on taking care of your patients and managing your staff.
- EHR Integration/Interoperability - The global digital health market is forecasted to surpass $379 billion by 2024. Integrating electronic health records (EHRs) with other technologies practices daily has helped propel this trend forward. One of the most significant inefficiencies many practices face is having an EHR that is not integrated or does not operate with another essential program or service they use. In 2020 and beyond, addressing this inefficiency will be a priority.
As with billing, keeping an eye out for what may help you manage your practice more effectively and efficiently will be essential. Start with writing down where you believe the most significant problems or inefficiencies rest and research how you can address them. If you need any help, you know who to call.
Bonus: Patient Experience
We would be remiss if we did not take a moment to highlight what may be the essential part of your practice: your patients. They are truly what keeps your practice going, and like any other business, you have to keep your customers happy. So whether it is setting up virtual visits or making a bill easier to pay, make sure to take the time to make your office experience as pleasant as it can be.
How to Prevent Claims from Being Denied
Last month, we shared the five ways Mednet makes you more money. Although the list was in no particular order, the first item was submitting accurate claims. As this infographic illustrates, the average cost to file a claim is $6.50. The infographic also details that the cost to resubmit a claim ranges anywhere from $25-$118. The total cost to submit, correct, and resubmit a claim can range anywhere from $31.50 to $124.50 — costing your practice thousands of dollars per year.
Here are some other troubling numbers from a report on beckershospitalreview.com:
- According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20% of all claims submitted
- As many as 65% of claims denials are never worked, resulting in an estimated 3 percent loss of net revenue
- Roughly 67% of all denials are appealable
We are not sure about you, but losing 3% net revenue does NOT sound like the best way to run a business.
Mednet gets paid on over 98% of all the claims we submit, so we firmly believe we are experts in preventing claim denials. Here are some of our top tips to help you prevent your claims from being denied:
Do Your Homework: Part I
The only real constant in the medical industry is the change. Your staff must be on top of any and all changes in rules and regulations. By fostering an environment of constant learning and improvement, everyone on your team will understand the importance of staying up-to-date, eliminating denials due to failure to keep current.
Do Your Homework: Part II
Look internally and investigate the cause of past denials. Understand where mistakes may have occurred and how you can avoid them in the future. If necessary, implement corrective actions to curb future denials.
Work As A Team
Denied claims affect the entire practice. Everyone on your staff should understand this. Even if they do not work directly with billing, each staff member should do their part to ensure the billing process is a smooth one. Help your team communicate what is needed, and, when a mistake happens, do not rush to place blame. Take time to search out the cause and help them understand how to prevent it from happening in the future.
Make Sure Pre-Authorizations Are Done Correctly
Pre-authorizations can help lower the number of claims denied, but only if they are for the scheduled procedure. Carefully document what was authorized and do checks before the procedure. If anything changes, document what was changed and double-check everything before submitting the claim.
This is a broad category that encompasses the above points, but also includes:
- Incorporate automation: Many software providers have tools that will help automatically update codes and procedures. Tools like this, as well as other project management tools, streamline the billing and claims process.
- Review your work: This seems like a simple step, but for one reason or another, it is often overlooked. Working as a team can help with this step because it is easier to spot someone else’s error than to catch your own.
- Meet deadlines: Meeting deadlines is essential. There is no excuse for having a claim denied because you missed a deadline. Again, working as a team can prevent a missed deadline.
In the end, you can help prevent claim denials by setting up a process for your team to follow. Set up a system that you can repeat for each claim that also allows for periodic review so you can determine where you need improvement.
It may seem daunting, but can you truly afford not to follow a process? It can cost you as much as 3% of your net revenue.
If it’s still too overwhelming, remember that Mednet is here to help with your medical billing needs. It might be a worry we can take off of your plate so you can focus on more important things, like your patients.
Five Ways Mednet Makes You More Money
Running a medical practice is difficult. No matter your specialty, you most likely face many challenges: compliance, administrative requirements, staffing issues, managing your revenue cycle, and cash flow. That is a lot to deal with, and we did not even mention ensuring your patients are happy and healthy.
Given all that goes into properly operating a medical practice, it’s important to know that help is out there and, even more importantly, how that help can propel your practice towards growth.
That’s where Mednet comes in. And there is one challenge we are exceptionally good at: ensuring your practice makes more money.
Let’s take a look at exactly how we do this:
Accurate Claims Billing
It all starts with submitting accurate claims. Because claims is how your practice gets paid for the services you provide for your patients, if the claims you submit are not accurate, they can be rejected or denied. And the process to clarify any errors can be costly in terms of both time and money.
Mednet gets paid on over 98% of all claims submitted. When we submit a claim for you, you’ll know that it is accurate. You will not have to worry about wasting time and money fixing inaccurate claims and delayed payments.
Improve Coding for Higher Reimbursement
A major part of submitting accurate claims is proper coding. Knowing which codes and modifiers to submit for which services you provide ensures that your practice does not lose any revenue. But it can also be a very complicated process, and one you need special knowledge to do correctly.
Mednet’s team of certified coders are trained in coding and chart audits. No matter your billing coding needs, we can meet them.
Aggressive A/R Management
No matter how experienced or good you are, claims do get rejected or denied. As stated above, resolving these issues can be costly. And if you fail to resolve the issues, you are leaving money on the table.
Mednet is aggressive in A/R management and and follow best practice standards. If a claim is rejected or denied, we quickly and efficiently follow up on your behalf to ensure there is no lost revenue.
Dedicated Account Managers
When you work with Mednet, we assign a dedicated account manager who handles all aspects of your medical billing needs.
Over time, your account manager comes to know your business and will feel like part of your staff. This strong relationship is important when it comes to handling the day-to-day challenges of medical billing.
Extensive Knowledge of the Industry
Mednet has been in business for over 35 years. Our Management Team has over 100 combined years of experience working in the medical billing field. We know the “ins and outs” of revenue cycle management, and you will feel confident that you are working with trained, experienced, and educated professionals who know how this industry operates.
You have a lot to worry about when it comes to operating your practice. Why not take something off your plate, a worry off your shoulders? Mednet gives you peace of mind because you know that the billing and coding is being taken care of.
Don’t waste any more of your precious time or money. Contact Mednet today to see how we can help revolutionize your medical practice.