The motto for getting paid is to Ask Early and Ask Often for Payment.

The fact is, the further into the collections process you go, the less likely a patient is to pay in full. If your practice’s patient collection efforts only go as far as issuing statements and generating “bad debt” reports of accounts that are turned over to collections, it’s likely that less than 50% of those collection balances will be recovered.

If this describes your practice, an improved strategy for Patient “Pre-Collections” that is both aggressive and fair should be implemented. Revenue for services rendered is the lifeblood of any facility, and if patients need to foot 40% of the bill, you can’t afford to miss out.

• Discuss payment expectations when you discuss procedure and appointment setting. If unable to pay in full, collecting a nominal portion the day before or the day of may make it worth proceeding.

• Collect a portion of co-pays upfront from patients. This isn’t always possible in the case of many emergency room admissions, but it is for specialty services such as elective surgeries and ancillary procedures.

Point of Service Collections

Point of service collections is just as important as insurance collections. Missed co-pays can quickly add up to a significant revenue loss. In the long run, point of service collections helps to cut down on statement costs and patient AR.

In order to

Patient billing is a significant problem for patients and providers.

ensure patients understand their coverage and are aware of their responsibilities — and that you get paid. Develop a self-pay policy, communicate it clearly to both staff and patients, and self-pay collection will become an integral part of your practice workflow.

People are not aware of their deductibles for specific procedures but when the time comes, it’s often the front office staff that has to educate patients about their insurance and the agreed-upon patient responsibility. Oftentimes, patients who hold high deductible health plans and other aggressive patient cost-sharing models are unpleasantly surprised with they find our they are ultimately responsible for their surgery. Patients who need to pay out of pocket for some or all of their medical care are frustrated by difficulties understanding what’s covered and what they owe, the lack of options for payment plans, and the poor timing of bills and communication around the process.

Front office staff are intimidated to collect payments or have not perfected Point-of-service collections, the art of asking for payment.

collecting some or all of the co-pay upon admission or before services are rendered

For Example:

Don’t Ask: CAN you can pay today?

Ask: How WILL you pay today?

Make it easy for patients to pay. 9 times out of 10, patients say they want to be able to pay their medical bills online. Facilities and healthcare providers can help ease the burden for patients by setting up customized payment plans, using patients’ preferred payment methods — which helps ensure that bills will be paid.

We don’t just set up a payment framework and then walk away; we are committed to giving providers the analytics, technology infrastructure, clinical support, and other resources that increase their likelihood of success. We also try to understand and address their challenges; for example, knowing that cash flow is a big issue, we’ve worked to make billing cycles shorter and more predictable.

The post Principles of Improving Patient Procedure Collections appeared first on MEREM Health.

We asked our expert coders:

“What is the #1 thing that can be done immediately to increase reimbursements?”

You may be surprised by the answer: 

Improve Documentation.

Your clinical documentation is the key to your reimbursements and the profitability of your practice. The simple answer to how you can make sure you are maximizing reimbursements for your practice is by improving your clinical documentation and detailing every surgical dictation… the end result can literally take your coding to the next level.

Detailed documentation is imperative.

You know what procedures you performed but remember, you can only get paid for what your notes say you performed. Documentation, such as the operative report and op notes are the only way a coder can translate the procedures performed into billable revenue via (CPT codes). Incomplete or vague documentation can lead to a major loss in billable revenue. By making sure you include the 4 following details in every dictation, Coders can determine the correct level codes are claimed so that you are reimbursed adequately.

Your time matters – Make sure to state the amount of time spent with the patient in the plan portion of the dictation. For example, “I’ve spent __ minutes face-to-face with the patient.” Having that time included could bump your visit code to the next level.

Classify treatment plans – State clearly if a fracture is seen and being treated either conservatively or surgically. This cuts down on addendum’s and corrected claims and helps get paid faster.

Detailed Dictations – State chief complaints, ROS, HPI, PFSH, and Physical exam clearly in dictation.  One extra detail could mean a higher level!

Erroneous diagnosis dictations cause delayed claims – Watch out for dictation mistakes on the diagnosis level.  For example, if a patient comes in for right ankle pain and the x-rays are dictated as left ankle x-rays which continues to the plan of care section, the coder will have to put the claim on hold and get an addendum made to clarify which ankle was actually examined.  Coding errors could delay the claim timely if not done promptly. 

How to improve accurate and timely coding

We believe Specialty providers deserve specialty coders.

At MEREM Healthcare Solutions, that is what we provide to Orthopedics and Sports Medicine practices. Every client deserves the expertise of experienced CPC coders. That is why we employ COSC coders for their specialized knowledge pertaining to complex orthopedic surgical cases.

CPC certification by the AAPC has become the gold standard with additional specialty certification available such as AAPC’s COSC (Certified Orthopedic Surgical Coder).

Get reimbursed faster by turning to an experienced team of certified professional coders to improve accurate and timely coding for your practice. Whether you scribe dictations or utilize an intuitive EMR, MEREM Healthcare Solutions tailors our coding strategy to fit the specific process used for your specialty physician documentation and will also assign and develop our coding staff around your specialty.

Charge Optimization

Working to implement the standard of including as much detail as possible is the first steps toward documenting iron-clad operative reports. Op notes are never written in stone, but the sooner they are finalized with as much information as possible, the sooner it can be coded and paid.

Improved documentation results in revenue improvement. Accurate coding results in faster reimbursement. With detailed documentation, coders don’t have to rely on addendums and delay processing claims. The turn around is quicker and more effective for the physician to be paid.

The coding team at MEREM Healthcare Solutions is trained to help your practice maximize billed charges. By reviewing every encounter note and operative report, our specialty coders will prevent under-coding and over-coding to ensure that every billable procedure performed is correctly reported. Additionally, our consulting team can help you increase charges by maximizing your clinic output and improving documentation quality.

The post Next Level Coding Begins with Improved Documentation appeared first on MEREM Health.

Birmingham, Alabama based specialty healthcare solution company, MEREM Healthcare Solutions, is preparing to expand their outsourced healthcare solutions to specialty practice physicians across the Southeast.

MEREM Healthcare Solutions aims to partner with rural healthcare providers across the Southeast such as individual physician practices, specialty physician groups, and healthcare institutions across the state of Alabama, Tennessee, Mississippi, South Carolina, and Georgia who are facing economic pressures and in need of revenue improvement, strategic practice planning, credentialing and insurance network management.

“MEREM Healthcare Solutions is more than an outsourced medical billing and coding company,” says MEREM Health VP of Operations, Brittney Tidwell, “we deliver unique solutions customized to fit the needs of individual practices that ensure improved practice performance and revenue cycle management.”

BRITTNEY TIDWELL
Vice President of Operations

Our mission at MEREM Healthcare Solutions is to provide our clients with superior, off-site medical billing management services while maintaining and exceeding the level of accountability, communication, and customer service that is valued in traditional on-site billing departments.

Providing high-quality medical billing solutions to support healthcare teams is something that we have been dedicated to for years. For practices facing significant denials and claims rejections, a specialized outsourced solution can be just what you need. We encourage physicians and practice owners to consider this… 

Patients seek out specialty care for specialized treatment of their health problems. Consider giving your practice the same quality of specialized care.

With MEREM Healthcare Solutions, Outsourcing Doesn’t Mean Offshoring

Offshoring means getting work done in a different country.

Outsourcing refers to contracting work out to an external organization. We will provide you with a billing team. We structure our billing services around a team, ensuring appropriate checks and balances, a unified strategic vision, and the convenience of a single point of contact readily available to direct your questions – your Merem Concierge. Additionally, your patients will appreciate having their phone calls received directly by one of your U.S. based billing team members.

When there’s a backup in your pipes, you need a plumbing specialist. When there is a backup in your revenue cycle, our customized revenue cycle solutions and healthcare management team of medical billing and coding professionals can help.

Outsourcing medical billing and coding significantly increase a physician’s confidence that the billing is handled accurately and efficiently. Merem Healthcare Solutions eliminates time, frustration, and expense associated with building and maintaining skilled professionals needed to achieve optimal reimbursement in the ever-changing and very challenging insurance industry. Above all, Merem clients know their business interests are in the hands of competent committed professionals.

By choosing MEREM, you can rely on our expert team of certified healthcare revenue professionals who understand payer requirements and know how to get claims paid and help you reach revenue cycle performance above the industry standards. The We utilize a 3-part process that has been proven to put more cash in your pocket:

1. Cut Costs by eliminating recruiting and training time, reducing labor costs, and improving accuracy.
2. Increase Cash Flow by resolving your denied claims and advise on ways to prevent them from getting you paid quicker.
3. Increase Charges by relying on our expert team to review each note or dictation in order to ensure you capture the maximum RVUs.

This process is a concept that provides benefit to all parties involved, but most of all to cut the cost of in house staff by providing expertise, advice, and resources designed specifically for specialty practice providers needs — areas including coding, supply chain or regulatory compliance.

If you are interested in learning more about MEREM Healthcare Solutions and the customized practice management and revenue improvement options that we can provide, please contact us or give us a call at (205) 329-7519. Our professional healthcare management team will consult and prepare customized practice solutions to fit the unique needs of your specialty.

The post Specialty Healthcare Solutions expanding outside of Birmingham, Alabama appeared first on MEREM Health.

Therefore, while we don’t want to take away from the amazing work of physicians, nurses, front desk employees, etc., our team at MEREM Healthcare Solutions also wants to make sure medical billers and coders receive the recognition they deserve for the critical role they play within the healthcare industry.

What Do Medical Billers and Coders Do?

While your patients might not see them during their visit to your medical practice, medical billers and coders are there every step of the way—from the initial examination to diagnostic tests to the overall treatment of the patient. Medical billers and coders are responsible for translating the entire patient visit into special ICD-10 codes for proper billing.

But, before you start thinking, “How hard can that be?” did you know there are more than 140,000 ICD-codes? And each ICD-10 code has its own purpose. For instance, there isn’t just one code for “pain.” Rather, there is one ICD-10 code for pain in the arm that is unspecified. Then, there is another code for low back pain, and so on and so forth.

Not only is it vital for these specific codes to be known, but it is also vital that they are used correctly, as one wrong code entry could cause a delay in billing and payment, which can hurt a medical practice’s profitability.

The Unsung Heroes – Off-Site or Outsourced Medical Billers and Coders

Although some medical practices try to utilize their front office staff to assist with the medical coding and billing of patients, this practice of sharing responsibilities is not as conducive for the profitability of the medical practice as outsourcing the billing and coding to a third party.

For example, a patient walks into your medical practice. Depending on your specialty, your patient might already be high-anxiety. When they walk in, the front desk person isn’t able to welcome them warmly because he or she is on hold with an insurance company. All the patient has done at this point, is walk into your practice, and everything is already off on the wrong foot.

However, if your medical practice outsourced your medical billing and coding, not only can you reduce your chances of errors when it comes to cash flow, you can also allow your front office staff and medical team to focus directly on the patient, which can both improve patient outcomes and patients reviews—which is a win-win!

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid medical billing and coding errors.

Merem Healthcare Solutions offers services for every step in a practice’s revenue cycle management. We can start from the beginning from credentialing and end with payment posting once an account has been satisfied. In addition to outsourced medical billing and coding, we offer a wide range of solutions which include auditing, consulting, credentialing, payment posting, practice management, and pre-collections training. Check out our website or feel free to call us at (205) 329-7519 to see how we can help run your practice like a well-oiled machine.

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The post <a href="https://aaoe19.snoball.events/e/merem-healthcare-solutions">WE’RE EXHIBITING at the AAOE 2019 Annual Conference</a> appeared first on MEREM Health.

The AAOE Annual Conference is a great opportunity for orthopedic executives to:

>> Earn CEUs and access unlimited resources

>> Explore resources that can help you leverage and gain market share

>> Sharpen your skills and gain knowledge about the business side of healthcare 

>> Stay current with the latest industry trends and newest practice management techniques

MEREM Healthcare Solutions looks forward to this annual event each year. Founded by orthopedic healthcare executives, MEREM Healthcare Solutions began as a solution to their on-going billing and coding problems. For over 10 years, MEREM Healthcare Solutions has been working to provide orthopedic and sports medicine clients superior, outsourced medical billing, coding, and revenue cycle management solutions.

Every practice is unique; Orthopedics and Sports Medicine is no exception, so our billing team seeks to develop a customized solution to fit those unique needs. MEREM Healthcare Solutions builds on that mission to add what 10 years of experience in the medical billing field has taught us: that, no matter the size, healthcare organizations need a strategic partner and that is what we are here to provide.

MEREM Healthcare Solutions has developed a training process that allows us to be among the experts in Orthopedics and Sports Medicine. Our Specialized Orthopedics and Sports Medicine Coding Solutions Include:

• All clinical and surgical documentation reviewed by Certified Coders
• Coding completed within 48 hours from receipt of all source documentation
• Coding experts that can educate your staff to ensure appropriate documentation and compliance
• Regular internal audits to monitor coding performance, accuracy, and compliance
• Quarterly reports on provider-level coding and documentation performance

We are looking forward to the opportunity to meet with your team. Be sure to stop by our booth #106 to chat with fellow orthopedic practice executives about how we can help enhance your practice profitability and to discuss measuring metrics against the industry’s benchmark standards.

Plus, you can enter to win a $100 Giftcard!

Want to learn more about how MEREM Healthcare Solutions serves orthopedic executives? Check out these blogs:

• Optimizing Surgical Reimbursements for your Orthopedic Practice
• Three Reasons Orthopedic Surgeons Lose Revenue

The post Planning for AAOE 2019 – First Time Attendees appeared first on MEREM Health.

Medical decision making drives the level of office visit

The medical decision-making portion of evaluation and management guidelines is what ultimately determines the level billed. Higher complexity in decision making justifies higher levels.

Evaluation and Management visits have three main components:

1. History
2. Physical exam
3. Medical decision making.

For established patients, guidelines state that only two of these three need to be met for a given level. The Center for Medicare and Medicaid Services advises to let medical decision making drive the visit.

What does “Medical decision making should drive the visit” really mean?

This is such a grey area in the guidelines that it is causing practices to over-bill or undercharge, which will ultimately cause them to fail an audit.

CMS stated, “It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed.” (Medicare Claims Processing Manual 30.6.1)

Many practices are so confused about what this means, that they just pick the middle level and call it a day. Those practices need clarification and education on how to get to the correct level for the service performed. MEREM can help!

Below are some examples to remember when choosing the level of an office visit to the bill.

• If the provider is seeing an established patient who is coming in for a recheck, ask yourself is the patient’s diagnosis improving or worsening?

– If the problem is improving, the level of service will likely be a level 2 (99212).

⁃ If the problem is worsening, the level of service is likely a level 3 (99213).

• For established patients coming in with a new problem, these level of service is likely a level 3 (99213) or level 4 (99214). The final level for this patient will depend on the diagnosis and treatment performed during the service.
• Code 99215 is used to report High MDM. 99215 is reserved for those patients who require extensive workup regarding Chronic Illnesses with severe exasperations or acute illness or injuries that threaten loss of life or bodily function. Management options for these patients may include IV drug therapy, Emergency Surgery or a DNR status because of poor prognosis.

Let MEREM Health help you conquer the challenges of coding your office visits. Call us to get a free quote at 205-329-7519.

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MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, also known as MIPS.

In November, the Centers for Medicare and Medicaid Services (CMS) released their FINAL RULE for the 2019 Medicare Physician Fee Schedule. This Final Rule will go into effect January 1, 2019 for many clinicians and it is the start to the new physician payment provisions also known as the QPP. The CMS Quality Payment Program (QPP) has two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

What is MIPS?

This is a healthcare law that doctors across the country, who accept Medicare patients, need to abide by in order to maintain or qualify for an increase in their reimbursement payments from the government. These physician incentives are based on clinical performance in four specific categories, Quality, Cost, Promoting Interoperability, and Improvement Activities.

MIPS category change review according to “HIT Like a Girl” podcast.

These MIPS scoring weights have changed each year. The biggest changes in 2019 are

• Quality score reduced from 50% to 45%
• Cost score increased from 10% to 15%
• Improvement Activities: Interoperability bonus removed
• Eligible clinicians must use 2015 edition or newer certified EHR technology
• Performance Threshold minimum increased from 15 to 30 points. Exceptional Performance Range is at least 75 points.

For 2019, the Weights and MIPS final scoring rules, we found this webinar from Healthmonix to be extremely helpful.

In summary:

1. Quality (45%) – Requires 6 measures to be reported with 1 outcome measure or high priority (specialty measure set)
2. Cost Performance Reporting (15%) – based on 8 measures, 10 minimum procedural episodes such as knee arthroplasty, or 20 acute inpatient medical condition episodes
3. Promoting Interoperability (25%) – Must report at least a 90 day period, Must use 2015 ed. or newer CERTEHR technology
4. Clinical Practice Improvement Activities (15%) – 40 points required, based on weight.

If you are preparing for MIPS 2019 reporting, we hope this blog prepares your practice performance measures.

At MEREM Healthcare Solutions, we want to be your strategic partner in making sure your practice needs are met and your practice improvement and profitability are the end result. Contact us today to learn how our knowledgeable and experienced professionals can help assist or consult you with EMR technology and MIPS and MACRA submissions for your physicians.

The post 2019 MIPS & MACRA – Are Your Physicians Hitting the Medicare Mark? appeared first on MEREM Health.

Did you know that physician compensation only increased for 37% of all independent physicians in 2017?  That’s a sobering thought that compensations have remained relatively flat for many physician specialties year over year.  And couple that with a decrease in overall practice cash flow and constantly changing coding rules, and you’ve got unhappy physicians and a financially precarious practice.

Clearly, the need to automate manual practices in the back office within a physician clinic is the key to improving cash flow and physician compensation.  And the industry trend appears to be that more and more practices are outsourcing their revenue cycle management (RCM) for just this reason.

Here are some of a practice’s revenue cycle challenges that can be resolved by using an outsourcing team to assist your practice:

Rework how your backend efforts are operating

Many practices that are outsourcing their revenue cycle challenges are able to implement backend efforts to process and reconcile their bills earlier and faster.  This obviously improves a practice’s ability to collect AND speed up reimbursements from payers.

Shore up inefficient billing practices

It is estimated that outsourced medical companies help physician practices experience fewer rejected claims and less time to receive payments from a payer within the first two months of outsourcing.  This fact clearly shows that money spent outsourcing can be recouped by a physician practice in a short period of time.

Take on newer technologies and processes unfamiliar to your practice

Many physician practices are unprepared and inexperienced at implementing technology-driven care.  An outsourced medical billing, coding and RCM company already has experience at what today’s latest tools can accomplish and can implement these best practices for you by either doing partial or full managed business office services.

Becker’s ASC reports that RCM outsourcing and extended business office services are expected to report a 42 percent overall growth rate from the fourth quarter of this year through the first quarter of 2019.  This means that outsourcing has become the norm as opposed to something only a select group of physician practices gamble on.

Here at MEREM Healthcare Solutions, we’d love the opportunity to show you how much we can improve your practice’s RCM so that your specialty practice is thriving financially.  Improving cash flow and physician compensation requires working hand-in-hand with an outsourced healthcare solution.

Is your medical facility leaving money on the table? Contact the professionals at MEREM Health today to learn how we can ensure you are getting paid what you deserve every time!  

The post Improving cash flow and physician compensation requires working hand-in-hand. appeared first on MEREM Health.

MEREM Health ranked among the Top 30 Medical Billing and Coding Blogs, Websites, and Newsletters to follow in 2018

According to Feedspot.com, MEREM Health was recently recognized as one of the Top 30 Medical Billing and Coding Blogs, Websites and Newsletters To Follow in 2018 because we are actively working to educate, inspire, and empower our readers with frequent updates and high-quality information.

These blogs selected in the list were ranked based on the following criteria:

• Google reputation and Google search ranking
• Influence and popularity on Facebook, Twitter, and other social media sites
• Quality and consistency of posts.
• Feedspot’s editorial team and expert review

Meredith Tibbs, Director of Coding for MEREM Healthcare Solutions was excited to be recognized among many of the organizational blogs that she follows and considers it a great achievement to be recognized among our peers. She said, “I use a lot of those other sites to keep updated within our industry!”

Anuj Agarwal, the Founder of Feedspot shared, ” This is the most comprehensive list of best Medical Billing and Coding blogs on the internet and I’m honored to have you as part of this! I personally give you a high-five and want to thank you for your contribution to this world.”

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