GeBBS Healthcare Blog

AHA President and CEO Asks President-Elect Trump For "Steady as She Goes" Effort on Healthcare

Posted on Tue, Dec 20, 2016 @ 11:00 AM

By Nitin Thakor, GeBBS President & CEO

AHA President and CEO Rick Pollack recently sent a congratulatory letter to President-elect Donald Trump and asking him to go slowly on changes to our healthcare delivery system, particularly when it comes to the Affordable Care Act (ACA). This is good advice since healthcare represents a significant portion of the U.S. economy and essential public services. Pollack explained his case in terms that abrupt changes could lead to significant instability for patients, providers, insurers and others.

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Tags: Revenue Cycle Management (RCM), Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions, Medical Billing BPO, RCM Solutions, Revenue Cycle Solutions

Beware of Secondary Injury to Your Wallet after an ER Visit

Posted on Tue, Dec 13, 2016 @ 03:00 PM

A recent article in US News and World Reportexplained a little known fact of which most patients are completely unaware. A trip to the emergency room could cause a secondary injury to a patient’s wallet. Even if a patient goes to a hospital included in his or her health insurance network, if the emergency room physician who treats the patient is not part of the health insurance network, the patient will be responsible for a separate and unexpected bill.

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Tags: Revenue Cycle Management (RCM), Healthcare Revenue Billing, Insurance Billing Solutions, Medical Billing BPO, RCM Solutions, Revenue Cycle Solutions

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

Outsourcing Chronic Care Management Is a Win-Win for All!

Posted on Thu, Sep 10, 2015 @ 08:00 AM

The Centers for Medicare & Medicaid Services (CMS) has begun paying providers for delivering non-face-to-face care to their Medicare patients with two or more chronic conditions. This is a win-win for everyone involved in the process. Patients will experience improved outcomes and physicians have the opportunity to increase their revenue streams. CMS created the new CPT Code 99490 to reimburse providers for spending 20 minutes per month helping their patients manage multiple chronic conditions.

Medicare has traditionally only paid providers for care management services as part of face-to-face office visits. Now, eligible providers will be reimbursed at approximately $42 per qualified patient per month for these services. The Chronic Care Management (CCM) payment applies to both Medicare and Medicare Advantage patients.

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Tags: Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions

New CMS Initiative Can Generate Revenue for Physicians

Posted on Wed, Sep 02, 2015 @ 05:30 AM

 

The 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT Code 99490 -- Chronic Care Management (CCM), reimbursing practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients. 

CMS has recognized that in the U.S. seven of the top ten causes of death are from chronic illnesses, with 85 percent of healthcare costs going to treat those diseases and two-thirds of Medicare dollars being spent on patients with five or more of these chronic conditions. 

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Tags: Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions

Bypassing the Insurance Companies

Posted on Mon, Aug 17, 2015 @ 08:00 AM

In an article entitled: “Boeing negotiates directly with more health systems” in this morning’s Modern Healthcare e-newsletter, it was reported that airplane manufacturer Boeing Co. will soon offer more employees the option of health benefits negotiated directly with local health systems. The employer, being skilled in the art of negotiations, is bypassing the big insurance companies and negotiating directly with providers. The company first used the strategy last year in Seattle to better control healthcare costs.

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Tags: Business Process Outsourcing (BPO), Insurance Billing Solutions

Top 10 Reasons Why You Should Outsource Your Revenue Cycle Activities

Posted on Thu, Mar 19, 2015 @ 12:12 PM

In today’s healthcare environment of shrinking reimbursements, due to governmental mandates and Medicare policy changes, the importance of maintaining a healthy revenue cycle is second only to providing the best patient care possible. Without an adequate margin there can be no medical mission.

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Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Medical Coding, Affordable Care Act, Insurance Billing Solutions, Offshore Medical Billing, Offshore Medical Coding, Medical Billing BPO, Offshore Revenue Cycle Management, Remote Medical Coding, Medical Coding BPO

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

Patient Access Management: The New Vanguard in Healthcare

Posted on Thu, Nov 20, 2014 @ 03:37 PM

With all of the changes in healthcare reimbursement policies and the influx of high-deductible patients, healthcare providers need to shift their patient access management strategies to meet these new challengesNo longer can the registration process be looked upon as a simplistic completing of forms and getting the patient into a bed. Today's patient access professional must be capable of highly skilled worksuch as reviewing referrals, obtaining authorizations, verifying eligibility, determining the patients’ willingness and ability to pay, requesting payment at time of service and arranging sophisticated payment schedules to ensure collection of revenue for services rendered.

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Tags: Revenue Cycle Management (RCM), Patient Access Management, Insurance Billing Solutions

Healthcare Consumerism and Patient Access Management

Posted on Tue, Oct 21, 2014 @ 11:59 AM

Healthcare consumerism is going to be an important factor in the new healthcare financial environment where many patients are going to be responsible for a large portion of their healthcare costs. Consumer self-service is already becoming common place in healthcare today. Access to healthcare kiosks and patient portals will become an expectation in patients’ healthcare delivery processes. Allowing healthcare consumers to research costs, schedule appointments, receive online statements and make electronic payments are just some of the options consumers are demanding.

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Tags: Revenue Cycle Management (RCM), Revenue Cycle Management (RCM), Patient Access Management, Insurance Billing Solutions