In fact, if healthcare practices are not careful, they could be losing revenue even as more patients come walking through the door. But why does this occur?

Where Does the Money Go?

There are many reasons behind a healthcare facility losing revenue while still seeing a great number of patients, including:

Inaccurate Coding

One of the most common reasons behind a medical practice losing money is inaccurate (or inadequate) CPT coding input.

Health care is always changing. With that, medical billing codes also continually change. Therefore, if the billing professionals within your medical practice are not staying up-to-date on coding, the revenue can be lost due to denied claims or reduced reimbursement.

However, under-coding can play a large part in revenue lost, too. Many times, if the billing department is unaware of what occurred during a patient’s exam or surgery, they can “undercode” for the services used because they just don’t know what exactly went on within the exam room.

It is estimated that a medical practice loses a minimum of $10,000 each year due to only undercoding. Thus, it is vital for the lines of communication to be open within a medical practice, especially when it comes to quarterly coding education and reimbursement protocols.

Poor Billing Practices

Within a healthcare facility, every department needs to follow best practices, especially billing. When poor billing practices occur, the result can take a huge toll on the medical practices’ finances.

Most of the time bad billing happens not because the people within the billing department are purposely making mistakes. But, just like in coding, if your employees are unsure about the what they are supposed to be doing in billing, financial losses in your medical practice can (and will) happen.

It’s critical during the interview process that you are using professionals who are competent in medical billing to fill your positions within the department. In addition, receptionists and other positions should be able to properly know how to file patient insurance and services so that the billing department receives accurate information to help prevent billing issues, as well.

Insurance Plans

Unfortunately, even if you perform the two tasks above well – bill correctly and code accurately – loss of revenue can still occur. How? Because of the insurance plan your medical practices do business with daily.

While some insurance companies are great about their reimbursement practices, other insurance companies will hesitate to reimburse what is due or might have a low reimbursement schedule.

If you happen to work with one of those insurance companies, it is easy for payments due to your medical practice to fall further and further behind in payments until they usually stop paying you altogether, resulting in loss of revenue. Therefore, be careful of the insurance companies you do business with to ensure they are not the reasons behind your loss of revenue within your practice.

Is your business losing money? Contact the professionals at Merem Health to learn about our consulting, outsourced billing, collections, and revenue cycle management services.

The post Is Your Healthcare Facility’s Revenue Moving in the Wrong Direction? appeared first on MEREM Health.

Heads Up for Healthcare – 

NEW E/M Coding Changes Coming 2019

We all know that change is the only constant in the Medical Coding world. This recent CMS release of coding initiatives in 2019 proposes a pretty significant change for Evaluation and Management (E/M) coding that can impact doctor visits for both the patients and the providers in a good way.

According to CMS Secretary, Verma Seema, “Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid.”

What patients see, is the attention and time spent with their physician. Physicians complain that the time spent inputting information cuts into face-to-face time with the patient. The pressure to increase patient loads requires providers to keep visits short but effective. Time is the common denominator that will be addressed through these coding changes.

What does that mean for you? Less is more.

The #PatientsOverPaperwork Initiative focuses on value-based healthcare by simplifying the complexity of required documentation during an office visit. This change will enable physicians to return to focusing on attentive, quality care by spending more time with the patient rather than spending their time documenting visit to meet the paperwork requirements involved.

E/M Visit Payment Changes & Reimbursement Rates

• E/M Coding levels 2-5 will be consolidated to a single reimbursement code and must meet the following requirements
  • EPF History (a chief complaint with 1-3 HPI elements)
  • 1 review of symptoms
  • And EPF Exam
  • And a Straightforward MDM

• Add on codes may also be applied for additional reimbursement and payment adjustments.

+     $5 for additional resources in complex E/M visits associated with primary care service

+     $9 for additional resources in complex E/M visits involving non-procedural based care

–      Multiple procedure payment reductions when E/M visit and a procedure are furnished on the same day

+     Add-on for a 30-minute prolonged E/M visit.

• E/M Level 1 rates will be adjusted
  • $24 for established patients
  • $44 for new patients

The proposed changes depicted above are in a 60-day comment period. CMS welcomes and encourages provider feedback as a critical part of the coding change process. This is to ensure that all coding changes benefit not only the patient, but the providers that treat them as well.

“As part of @POTUS‘s Cut the Red Tape Initiative, CMS launched our Patients Over Paperwork Initiative to reduce unnecessary and redundant regulations so that doctors could focus on their primary mission – taking care of their patients.” #PatientsOverPaperwork

— Administrator Seema Verma (@SeemaCMS) July 25, 2018

If you have questions or would like to provide feedback about how these coding changes may effect your E&M visits and reimbursement, you can join the conversation via Twitter using hashtag, #PatientsOverPaperwork and tweet to @SeemaCMS and @MEREMHealth.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008. We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

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