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In fact, it’s a driving factor to staying in balance financially for any healthcare institution at large.
And, the thing that people at large will be agreeing is – When the finances become tight, it is always worth looking at the cost-saving solutions.
The bottom line is – When health services are rendered, healthcare institutions and organizations should bring positive figures coming down the road.
Whether it is about serving patients or taking care of the other maintenance operations, making sure you avoid operations that kill the productivity, time and excessive resources at the same time.
It’s again more like an initiative in the right direction.
Well, what’s going to turn out?
To answer – Seamlessness and convenience at large!
Thus, to address the cost concerns, a lot of private healthcare institutions as well as organizations look their way towards outsourcing.
The fact is –The rising costs any healthcare organization will ever bear.
Again –From maintenance to having personnel and qualified staff on board, and then again ensuring things such as payment is received when services rendered in the best possible manner.
Therefore, responsibly taking care of two or more operations, even out of the context of serving patients becomes a big point for any healthcare organization to the greatest degree possible.
In saying so –We are going to discuss when any hospital or healthcare institution should think of outsourcing its revenue cycle management.
In addition to it – We will also discuss what revenue cycle management is, and what you should learn about, to the fullest potential.
Let’s get started and make sure to stick with the guide.
Suppose – A patient hits to arrive at the clinic.
Discussed the sufferings and difficulties, or needed advice on ailment he was affected through.
The doctor or specialist treated, and finally things have been sorted out successfully for the patient.
Now, the thing is – In order to record the complete process in the best possible manner effectively and efficiently becomes a deal one has to cover.
How about the situation – When the healthcare service provider doesn’t get the payment for the services rendered?
Well, there are countless instances to consider.
Thus, the revenue cycle management is all about supervising, administrating and undertaking the complete process of generating revenue out of the services rendered.
And, now –Would you consider outsourcing it because you have got a lot of patients coming to your healthcare institution and you want to serve without looking at every aspect we talked about?
To add – That’s the key.
As we discussed about the instances of outsourcing revenue cycle management, and now – It’s time to discuss what includes in revenue cycle management!
The trend of outsourcing essential operations is more connected to bring about the convenience and seamlessness in the medical operation and rendering of other services.
It is one of the best forces to ensure things stay up to the mark, and have complete vibrancy in any regards possible.
That’s how it keeps things in the system.
Thus, would you think of outsourcing for revenue cycle management?
Well, just see the growth of outsourcing in the healthcare industry, and you will surely think of doing it at the best.
On a sweeter note – Thanks for the read, though!
Thus, what matters is having all the facts laid down on the table of discussion.
Now, we won’t discuss straight up the context; however, it’s again important to keeping a complex reasoning and constructive view on what we will be sharing hereon.
Therefore, consider Medicare Cost Report as a charge sheet or financial report that is always put forth and submitted in the most standardized formats possible.
This has now become pivotal as well as mandatory by far.
Well, to prevent it from the rejection.
If your report gets rejected, then no reimbursement and things will backfire drastically on you!
Such Medicare Cost Reports are submitted to the Centers for Medicare & Medicaid Services (CMS).
Furthermore, CMS keeps the complete task and aligns Medicare Cost Reports in the Healthcare Cost Reporting Information System (HCRIS).
The one who submits such Medicare Cost Report are Medicare-Certified Institutional Health Care Providers.
Again, you may have questions what CMS stands for and their purpose of existence in the complete story?
To ascertain the fact, CMS is a part of the Department of Health & Human Services (HHS) that oftentimes looks into several federal healthcare programs.
CMS sticks with a one-stop approach, that’s more about value-based reimbursement.
Including this, the department also administers the Health Insurance Portability and Accountability Act (HIPAA) and Medicare Access and CHIP Reauthorization Act (MACRA) law.
Moving forward – Stick with the guide since beginning is always playful and adventurous.
In short, let’s answer quickly questions readers may have at large.
This Medicare Cost Report requires Intern & Resident Information System Data to not get rejected.
This Medicare Cost Report requires a Detailed Listing of Bad Debt Listing to not get rejected.
This Medicare Cost Report requires a Detailed Listing Of Hospital’s Medicaid-Eligible Days to not get rejected.
This Medicare Cost Report requires A Detailed Listing Of Charity Care and/or Uninsured Discounts to not get rejected.
This Medicare Cost Report requires a Detailed Listing Of Home Office Cost Statement (Home Office or Chain Organization) to not get rejected.
Unless you do it, things will become messier with the passage of time since this can affect your venture financially under the program.
Thus, it’s always recommended that you consult and have a constructive view on the parameters we have discussed so far.
With that being said – Do share what is that you loved the most about the guide.
On a sweeter note – We at Monarch RCM are more committed to assisting and helping you out constructively to ensure you stay at the safer side.
And, thanks for the read, though!
Is it – You want the complete context to be covered to the fullest potential?
If you answer yes, we have now got you all covered.
Whether you are new to the update or just getting a refresher, which just depends on the level of information you want to have things rolling in positively if you are a Part A Provider, Medicare Contractor, or other PRRB Stakeholder.
To make the context completely sensible and understandable, let’s discuss what is what:
Part A Providers
When it comes to providing Inpatient Care in the Hospital, Skilled Nursing Facility Care, including Hospice as well as Home Health Care, Part A Providers comes into the picture.
You can call Private Health Care Insurer Medicare Contractor. The best of everything – They manage to process Medicare Part A and Part B (A/B) Medical Claims, including Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
Those who directly involve in PRRB Electronic Filing and make things go as expected and required complying with the statutory norms and regulations, PRRB Stakeholders take the courage to go hand-in-hand.
Now, it has become completely viable to discuss the guide more thoroughly, getting every equation keeping forth for a constructive understanding and reasoning.
Along the same lines, PRRB publishes its rules, current alerts, final substantive and many other jurisdictional decisions to take a look at.
With that being said – Here’s the next question that comes up straight.
Following everything – Now, we are going to share a good update.
It’s one of the biggest breakthroughs that the Department of Health and Human Services (HHS) has finally decided and worked upon to creating a new E-Filing System to speed up such appeals and claims.
Well, the system works amazingly seamless for Hospitals & Other Medicare Part A Providers, further settling beneficiary appeals or claim disputes down further in the most unbiased and clearest manner possible.
First of all, OH CDMS’s full form is – The Office Of Hearing Case & Document Management System.
It’s a web-based portal that can allow Health Care as well as Part A Providers to submit claim appeals or disputes they felt affected from.
The situation was uncontrollable and dense to take over.
Well, when final determinations were laid out, Medicare Contractors, PRRB Stakeholders as well as Part A Providers felt helpless and found unresolved with their appeals and claims.
That’s how the Department of Health & Human Services (HHS) took things on radar and introduced the New Electronic System for Provider Reimbursement Review Board (PRRB) Appeals.
HHS has significantly altered the best versions and made sure things go systematic and in the best possible manner.
With that being said – We would like to know what are your thoughts about the guide!
Do comment, and on a sweeter note – Thanks for the read, though!
Now, we are going to discuss what is Medicare Inpatient-Only (IPO) List?
Well, not now.
It’s for low-income people and their long-term care. It includes:
This coverage comes with a major medical care for seniors.
Do follow and learn more about Medicare Cover.
This covers Inpatient Hospital Stays, Home-Health Care Services, Short-Term Nursing Home Care, Including Care In Hospice & A Skilled Nursing Facility!
It’s a Medical Insurance that covers Laboratory Tests, Medical Equipment, Mental Healthcare, Doctor’s Services, Outpatient Care, and Medical Supplies & Preventive Services.
It has Medicare Advantage Plans that offers Dental, Vision, Hearing Programs & Coverage from a Private Insurance Company. Furthermore, this plan may include Rx Coverage.
It has the coverage for Certain Prescription Drugs. With that being said – It’s a voluntary program that offers Low Premiums and Wide-Access to Drugs!
Similarly, why not to discuss about Inpatient & Outpatient Care?
It requires for patients that need immediate hospitalization on a doctor’s order. Following their admission in the hospital, they get treated till they are discharged.
This is a sort of care that may include Medical Procedures, Tests and Services that patients get without being admitted or for a stay of less than 24 hours in the hospital.
Again, it’s high time to discuss what our subject title says us all about.
Total Knee Arthroplasty (TKA), also known as Knee Replacement Surgery, has now called off from Medicare Inpatient-Only (IPO) List.
All it means the procedures as well as services involved in Inpatient Care does not have Knee Replacement Surgery included in it.
This is a change has already been made to live by CMS which is The Centers for Medicare & Medicaid Services.
To ensure we are on the same page and follow the context constructively, every year CMS evaluates Inpatient & Outpatient Only List, and makes amendments as needed and required.
Therefore, to be a healthcare profession or doctor, you always have got to understand the seriousness of these notes and changes to stay updated and advanced since this can impact reimbursement and affect other intersections pertaining to the procedure at the same time.
P.S. It’s never easy to do all we can to have perfect medical billing solutions in place. That’s why we at Monarch RCM recommend doctors, medical and healthcare professionals to contact us. We provide robust and constructive medical billing solutions to ensure you get all covered. Therefore, do contact us, today!
On the same note – This removal has also been a significant advantage to patients.
Patients who want to have their Knee Replacement Surgery to be done in a day can have it treated and leave for home later that same day.
Needless to say – We can understand the fact ‘Outpatient Knee Replacement Surgery Has Just Arrived’.
Do share your thoughts, and comment below what is that you liked the most!
Similarly, thanks for the read, though!
More like Machine Learning (Artificial Intelligence into Healthcare Industry).
Now, it’s a way to give Reliable, Accurate & Concise Medical Care to Patients.
In fact, Big Hospitals around the world have started investing in Healthcare AI Applications.
Sounds something we are unfamiliar with?
Well, yes – It is.
The magical part of AI in Healthcare industry is to automate Hospital, Clinical & Medical-Related Administration & Functioning in the best possible manner.
Thus, it’s so rewarding and worth the deal.
Let’s dig and get to the point.
We use Electronic Health Records.
All it means is we can now store Medical Health Records & Other Details of the Patients Electronically.
The best part is – It avoids cumbersome paperwork.
What we ensure that the healthcare provider is properly reimbursed for their services.
It’s something we have been doing for a longer period of time.
Once a patient is diagnosed and treated with right medication, Medical Coder records the disease or symptoms, and translates them into numerical value.
What it does further the Medical Biller takes all the records, and prepare for Financial Billing Report to see how much a patient has to pay, and if anything is covered in patient’s insurance coverage.
Thus, if you own a Hospital or Clinic, you always need Medical Billing & Coding Services in place.
Schedule an appointment and get to the work straight for the betterment and accuracy, today!
Imagine how amazing it would be?
So, it’s good to share – Artificial Intelligence (AI) is becoming very promising in Healthcare Industry.
To add – Optimizing Patients transfer between Departments can speed up the operation process and effectiveness in the treatment.
The reason is – Widespread AI Use can make our life better and easier.
Furthermore, it will become possible to identify High Readmission Risk Patients & figure out Early Sepsis Prediction Everlastingly.
The best of everything – Doctor Offices & Hospitals can simply explore more into Patient’s Medical Background and History, and further avoid any wrongful Diagnosis.
So, you can state that Healthcare AI can Perform, Assist with Diagnosis, Decision-Making, and Therapy Recommendations & Healthcare Management at the same time.
Have you been to Mental Health Conditions such as Schizophrenia & Posttraumatic Stress Disorder?
If yes, follow the guide.
In addition to it, is Medical Marijuana a questionable term?
Well, to clear objections, it is because it works pretty well to cure severe disorders and diseases.
Are we still not sure?
Frankly speaking – It’s time to dump unreasonable myths.
Consider it a brain disease! It destroys memory and thinking skills.
It’s when you lose desire to eat!
Call it an Inflammatory Bowel Disease (IBD). Affected people experience inflammation in their digestive tract!
Reduction in body weight!
It’s a neurological disorder. People with Epilepsy happen to create unusual behavior, sensations and loss of awareness!
Eye disorder! It causes blindness.
People with this disorder experience double vision weakness!
Contractions of body muscles! However, painful, though.
It’s a disorder that affects individuals with gastrointestinal disorders, food poisoning, motion sickness, migraine and low blood sugar.
Thus, we covered why Medical Marijuana is inevitable and vital enough!
Similarly, we have something to share.
P.S. Are you looking for Medical Billing Experts? Do you need Medical Billing End-To-End Service? If this is what you are thinking of, then it’s high time to get started with us at Monarch RCM! We provide clients with One-Stop Solution for RCM, meaning Guaranteed Client Satisfaction. With that being said – Let’s schedule an appointment, today!
Even, Cancer is disturbing disease.
It gets cured through Medical Marijuana.
Now, we have a question – How effective it seems to you, just comment!
The best part is – Medical Marijuana has been proven to improving human lives.
It’s good and super effective to cure typical disorders and diseases at the same time.
Furthermore, things typically go off due to musculoskeletal aliments at the same time.
In saying so – From Joint Deformities to Pain in the Muscles, what measures do you take to ensure you are given an edge to cope up with the difficulties and minimize pain effect by far?
With that being said – Do comment and share what you do uniquely for sure!
Well, here in the guide itself, we will be discussing the importance of Orthopedic Care which we usually neglect and do not take into the consideration.
So, the question is – Are you the person who feels completely Off-Track and feel difficulties in performing everyday operations in your life?
If you are the person who has a vast range of Musculoskeletal Issues such as Osteoporosis, Arthritis, Bone Tumors, and Sprained Ankles, then it’s certain – You are a good candidate for Orthopedic Care.
Yes, you need the care that certainly helps you recover and bring about the best version of yourself.
P.S. Are you looking for the robust and highly preferred Medical Billing Solutions? If yes, do contact alphabillingsolution.com and get yourself started right away!
Are you a person who goes along and have deformities issue?
If this is what it is, then it’s high time to get note of Orthopedic Care since this will manage to get you out of the pain you have been for a longer period of time!
And, at the same time – Do share your opinion in the comment below!
Well, it is!
We will in the post itself, discuss why Tele-medicine is trending by now and then.
So, do follow through the guide as well as understand its benefits at the same time.
Therefore, let’s get started!
Now, we will start with benefits to ensure that we understand how effective Tele-medicine has been so far in our lives.
Well, we discussed what Tele-medicine is as well as benefits you should be looking after!
P.S. Are you looking for Medicine Billing End-To-End Services? Do you perform medical practices or work at ambulatory surgery centers? Furthermore, does it become impossible to submit medical billing, manage AR, and improve collections and capture hard to collect payer reimbursements? If this is the case with you, then all you have got to do is to get through us at Monarch RCM since we will help you take up each activity efficiently! With that being said – We are looking forward to hearing from you!
This is not an April fools joke, it is really happening. Effective 01 April 2019, all WC claims will be paid using the new and increased formula released by the NYWCB. As many medical practices know that the WC fee schedule has not changed for the past 9 years, and many doctors have stopped seeing worker comp patients due to lack of reimbursement and many different problems with worker comp carriers. I am not going to discuss the various problems with worker comp carriers, I will say that out of 100 claims only 50-60 % get paid or even less for some doctors due to lack of information in their billing department or contracted billing companies. This is implemented to improve the quality of Healthcare for patients and for Medical Providers.
Now, let’s talk about medical reimbursement fees.
Effective 04/01/2019 conversion factor and RUV (Relative Value Unit ) is getting changed.
There is a conversion factor for each geographic region and general type of medical service provider (e.g., E&M, surgery radiology or maybe medicine.)
The region is divided into 4 parts, Region 1 and 2 will be identical, I mean medical reimbursement fees will be the same.
The fee schedule is updated for Medical (It’s for all specialties), behavioral health, Chiropractor/PT dental, pharmacy, DME and podiatry.
DME codes are not covered by worker comp, however, DMEs are covered with a specific CPT code and its subject to invoice cost and other things.
Now you must be wondering that if I can show some quick example so you can get a clear idea about changes, see below for the difference between the updated and old rates. (Region I and Region II are not identical on old Fee Schedule but they are Identical on the New Fee Schedule)
99204: $114.20 (Old)
99204: $163.85 (New) Difference: $49.65
99214: $71.40 (Old)
99214: $102.45 (New) Difference: $31.05
99244: $181.96 (Old)
99244: $261.10 (New) Difference: $79.14
· Region II:
99204: $119.60 (Old)
99204 : $163.85 (New) Difference : $44.25
99214: $74.89 (Old)
99214 : $102.45 (New) Difference : $27.56
99244: $190.60 (Old)
99244 : $261.10 (New) Difference : $70.50
· Region III
99204: $136.78 (Old)
99204: $187.39 (New) Difference: $50.61
99214: $85.53 (Old)
99214: $117.17 (New) Difference: $31.64
99244: $217.97 (Old)
99244: $298.60 (New) Difference: $80.63
· Region IV
99204: $148.69 (Old)
99204: $203.76 (New) Difference: $55.07
99214: $92.97 (Old)
99214: $127.40 (New) Difference: $34.43
99244: $236.94 (Old)
99244: $324.69 (New) Difference: $87.75
I have mentioned only 3 very commonly use CPTs by most of the medical providers, this new fee schedule is applicable on all billable codes, again DME fee schedule depends on invoice cost. Medical Testimony and Phone DEPO Refer to Rules (as per my suggestion don’t change old fee schedule on these two)
Many Medical Biller’s and medical billing companies don’t know about this update go ahead and ask them about this update. Some doctors are happy with their current medical billers because biller just shows the things which they want to show medical doctor and medical providers are too busy to check data of reimbursement and open items.
Most of the time medical biller’s are unable to reach any worker comp case manager or Customer care department and they keep leaving voicemails and notes into the system, this leads to nowhere, old claims still sitting down in system for years and eventually they adjust/write-off the claims after 2 years and medical doctor don’t even know about these loss. I can understand that there are few Govt. carrier are really tough to deal with, I can show you many examples. To deal with these Govt. carriers there are many easy ways to reach them and get claims paid in no time, but people are not creative any more they just want to finish the work and go home, that’s it.
After this new fee schedule, I guess medical provider should not lose more money because this new fee schedule is equivalent to Commercial fee schedule.
I hope this information would help many medical doctors to improve cash flow and may increase revenue after 04/01/2019 would very help full for all people in the Healthcare industry especially in New York. One more important thing, This new fee schedule is also applicable on No-fault claims.
And Please, don’t criticize this article just send feedback and ask any question if you may have I will try to resolve everything you ask, send me email or drop me a message in the box.
Also, please share if you like this article.
Blog Written By: Raman
My Email: Raman@monarchrcm.com
Credit: http://www.wcb.ny.gov and https://www.optum360.com/