GeBBS Healthcare Blog

Why the Government is Outsourcing (and You Should, Too)

Posted on Tue, Apr 30, 2019 @ 07:30 AM

The data is clear – policymakers are making every effort to reduce healthcare costs, particularly as states struggle with significant budget deficits across the country. To do this, many state governments have elected to outsource the management of Medicaid and Medicare programs to managed care companies.  According to Modern Healthcare, 34% of Medicare beneficiaries are now enrolled in a Medicare Advantage plan, which is administered by a private payer. Similarly, 77% of Medicaid beneficiaries are enrolled in some form of managed care plan.

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Tags: Health Information Management (HIM), Revenue Cycle Management (RCM), Accounts Receivable (A/R)

Is It Time for a Billing Operations Check-Up? How to Assess the Health of Your Revenue Cycle

Posted on Thu, Apr 04, 2019 @ 07:35 AM

Balancing the competitive landscape that comes with physician practice consolidation combined with population health and the shift to value-based care is a lot to consider for busy hospital physician practices.  Add in the constant changes in regulatory guidelines, enhancing the patient experience and most importantly – a continued focus on quality and safety and most hospital administrators have little resources left to focus on improving the revenue cycle.

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Tags: Accounts Receivable (A/R), Offshore Medical Billing, outsourced medical billing, RCM Solutions

Best Practices for Identifying Patients Who Have the Propensity to Pay Before and During POS

Posted on Wed, Jul 13, 2016 @ 05:00 AM

With cash flows declining, margins shrinking, and bad debt on the rise, it's more important than ever for healthcare providers to maintain a steady stream of income. If your organization has not implemented an end-to-end, comprehensive best practices revenue cycle management (RCM) solution, it is time to do it! You don’t have to add staff; just call on an experienced outsourcing firm with 10+ years of RCM experience with expertise in multi-specialty collections and billing. They will be able to deliver an all-inclusive RCM solution that follows industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of their proven experience and expertise.

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Tags: Accounts Receivable (A/R), Offshore Medical Billing, Self-Pay Collections, Medical Billing BPO

Sobering Statistics about Growing Patient Self-Pay Amounts

Posted on Mon, Dec 14, 2015 @ 10:00 AM

With the growing number of high deductible insurance plans and the Affordable Care Act (ACA), patients are now responsible for up to 35 percent of their healthcare delivery costs. Here are some staggering facts from MGMA and McKinsey & Company:

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Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

The New World of High Insurance Deductibles Requires New Solutions

Posted on Mon, Dec 07, 2015 @ 11:00 AM

The amounts for insurance deductibles continue to grow each year and there is no end in sight to these increases. With more and more patients opting for high deductible, low premium commercial health insurance policies, and the growing usage from the Affordable Care Act (ACA), providers must seek ways to collect these large deductible amounts at the point of care, using an integrated approach that includes call centers and comprehensive end-to-end revenue cycle management, coupled with compassionate collection training.

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Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

With the Start of ICD-10, It's Now About Reducing the Denial Rate

Posted on Fri, Oct 23, 2015 @ 07:00 AM

The world did not come to an end on October 1, 2015. With the start of ICD-10, healthcare professionals anticipated an overall reduction in productivity of their billing staff. In a pre-October 1 survey, 94% of respondents indicated that they expected increased denials, but only 30% had done any work toward solving the problem. 

If you are one of these, you are suggested to begin immediately to improve your denial management processes and your ICD-10 coding. Most providers, payers, and even CMS expect there will be a noticeable increase in the coding denial ratios, which currently range between 15-20%, and may actually double. Though, by design, ICD-10 is expected to reduce the denial rates; in the short term there is bound to be reduced collections, higher denial ratios, and lower productivity.

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Tags: ICD-10, Accounts Receivable (A/R), Best Practices, Insurance Billing Solutions

Compliance with Credit Balance Resolution Rules Does Not Have to Be Difficult

Posted on Wed, Jun 17, 2015 @ 05:00 AM

Credit balances are unavoidable and time-consuming. However, by law, they must be resolved. This activity does not have to be difficult even for already over-worked billing staffs. Professional outsourcing services are available to help with this growing challenge.

These services can be customized to fit into your specific workflow and increase your staff’s productivity, allowing you to increase the volume of accounts resolved on a daily basis, without hiring extra FTEs.

There are professional outsource companies that specialize in enhancing the financial performance of your revenue cycle management and related processes. They act as your partner to work within your legacy billing systems to research accounts in credit status, determine the root causes of the credit, and take appropriate corrective actions to resolve your credit balances. They leverage their healthcare expertise, technology, and qualified personnel resources. There is no capital outlay required.

Incorrect adjustments, erroneous credits, and misuse of debit codes make the credit balance task challenging without precision. 

In contrast, professional outsource analysts are diligent and well-trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. Their services are highly client-centric. They understand a professional and cooperative environment is the key to resolving credit balances, many of which become account corrections, as opposed to actual refunds.

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

Six Benefits and Results of Having a Good Credit Balance Resolution Program

Posted on Wed, May 20, 2015 @ 09:00 AM

In today’s healthcare environment, credit balances are commonplace. The healthcare industry has a high incidence of credit balances due to multiple parties paying claims. The way that various information technology (IT) systems operate also creates credit balances.

Each provider must determine its credit balance strategy -- implement an internal program, which usually requires adding staff; outsourcing this work; or ignoring it. This last option is not optimal or realistic, given penalties for failure to comply with regulations on both the state and federal levels can be significant.

The common result is that healthcare providers do not want to add staff, if it can be avoided, and credit balance resolution provides a substantive distraction from the staff’s primary billing and collection focus. Among the reasons for this, is the provider belief that it’s painful to pay staff members to “give money away.” And, once behind in their credit balance resolution work, it is very difficult to catch up.

This leaves as the best alternative for handling credit balance resolutions – outsourcing! Following are the six top benefits and results for outsourcing your credit balance work:

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

10 Best Practices for Credit Balance Resolution

Posted on Tue, Apr 28, 2015 @ 07:00 AM

Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial risks. Researching and correcting posting errors, duplicate payments, overpayments, and misapplied credits are not only time consuming, but also expensive. However, failure to address these credit balances in a timely manner may result in missed billing opportunities, and when associated with government payers, may also bring compliance risks and penalties. Following are 10 best practices to help you with your credit balance resolutions:

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

ERAs Are a Win-Win over Paper EOBs

Posted on Thu, Feb 12, 2015 @ 08:52 AM

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Affordable Care Act (ACA) mandated that all healthcare plans adopt and support ERA operating rules before January 1, 2014. 

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Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Accounts Receivable (A/R), Insurance Billing Solutions