GeBBS Healthcare Blog

Be Prepared for "Surprise" Medical Billing

Posted on Wed, Feb 08, 2017 @ 12:45 PM

A recent article on the Radiology Business Management Association (RBMA) web site discussed consumer’s frustration with the cost of medical care as being at an all-time high as many purchasers of narrow-network, high-deductible and high-co-pay health plans are finding out that the benefits they get from their monthly insurance premiums are much more limited than they thought. One target of their frustration is “surprise” medical bills for services such as radiology, as well as other medical specialty services that a patient may receive from an out-of-network (OON) physician, while either receiving emergency care or a planned treatment at an in-network facility. It is an issue that has been covered by the likes of Consumer Reports and numerous other publications in recent years.  In response, state legislators in nearly two dozen states are either considering or have already passed laws to protect patients from such unexpected/surprise bills.

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Both California and New York have passed “Surprise” Medical Billing laws. The California Law applies to plans and insurance policies issued in California, amended, or renewed after July 1, 2017.

It is important for providers, health plans, and insurers in California to quickly create a plan to successfully navigate this new law. It is also important to note that these new California and New York regulations may be harbingers of laws elsewhere as it represents the next step in the evolution of state legislative efforts to address the tricky issues that arise when beneficiaries receiving OON services without a reasonable opportunity to consent to them.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle and provides tailored insurance billing solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. An expert outsourced billing partner can deliver solutions specific to each client’s need, while working with a client’s host system and using its tools to build efficient workflow processes with higher output through the use of a hybrid of automated and manual solutions.

The healthcare environment is changing with these new “surprise” medical billing laws, The Affordable Care Act and whatever evolution may follow, and the transition to ICD-10 all put added layers of expense and complexity on our already burdened billing systems.  Patient volumes are on the rise with the newly-insured population, and high-deductible plans putting added pressures on revenue cycle operations and the drive to collect payments. 

The key to success is access to a large pool of outsourced, qualified denial management experts who can work in any healthcare environment and that understand the new compliance laws, such as “surprise billing,” and how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  Outsourced RCM analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Patient Access Management, Medical Billing BPO, Offshore Medical Billing, outsourced medical billing

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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However, he was not so cautious when it came to Stage 3 Meaningful Use and M&A mergers. Pollack urged the President-elect to cancel Stage 3 of Meaningful Use, standardize the M&A merger review process, and reform the RAC program.

Pollack's letter highlighted five areas of concern for hospitals: reducing the regulatory burden; enhancing affordability and value; continuing to promote quality and patient safety; ensuring access to care and coverage; and continuing to advance healthcare system transformation and innovation.

In my opinion, much of what Mr. Pollack asked for makes perfect sense. It is my sincere hope that President-elect Trump will understand the consequences of abrupt changes to any financial system. He has already softened his stance on cancelling ACA on Day One of his administration. There are many things wrong with the ACA and reform is needed. I am hopeful that thoughtful men and women of goodwill will come up with a new plan that includes more participation of the private sector and the ability to sell health insurance across state lines.

This will provide a replacement plan that continues to provide a mechanism for individuals to obtain affordable insurance coverage, with realistic deductible amounts. Everyone who works in healthcare knows that the regulatory burdens faced by hospitals and physicians are substantial and unsustainable.

I remain hopeful that thoughtful reform can be accomplished, and we look forward to working within this new healthcare delivery system.

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

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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Is this a big problem?

Research conducted by Yale University found that roughly 2 of 10 in-network visits involved a doctor not in the patient's insurance network. Going to an in-network hospital does not mean all your charges will be covered.

There is some slight hope in these situations. If you are attended by an out-of-network doctor, it doesn't necessarily mean financial calamity. That can depend, in part, on the patient's insurance coverage. And, some states like New York have laws that offer some protection against surprise bills, although the extent of that protection varies.

There are limited options to rectify the unexpected charges. Patients can ask that the claim be processed again as in-network care since the patient had no way of knowing the doctor was out of network or they can try to negotiate a lower bill.

In recent years, especially since the creation of the Affordable Care Act's public insurance exchanges, insurers have formed networks of doctors and hospitals, in part, to gain some leverage for negotiating reimbursements.

When the medical treatment is an emergency situation, you don’t always have time to question the physician’s insurance network coverage. However, if you have time, it’s a good thing to make sure your attending physician is part of your health network.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Solutions, RCM Solutions, Medical Billing BPO, Healthcare Revenue Billing, Insurance Billing 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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Hospital systems are beginning to screen patients in high-deductible plans for their propensity to pay, and many are developing systems to collect in advance of care. The reason is the rise in high-deductible health insurance policies that are challenging hospitals and physicians across the country to change the way they prepare for and collect payments from people who are getting hit with large out-of-pocket costs for care. Hundreds of patients, many of them newly insured, are causing some hospitals to “drown in debt” from these high deductibles not covered by their plans.

Here are just a few of the best practices an experienced outsourcing company will bring to your RCM and help you identify, at the POS, patients who have the propensity to pay for their services. Collections at the point-of-service are of ever-growing importance. Collecting payment at or before the POS reflects the industry's experience that as more time passes after care is delivered, a patient's propensity to pay decreases substantially. By requesting payment before services are rendered -- or by making agreed-to- payment arrangements have the potential to substantially reduce uncompensated care and the resultant bad debt.

The revenue cycle starts at registration, so capturing accurate patient information during registration is critical. Documenting accurate patient demographics at the first point of contact lays the groundwork for efficient, effective payment collections.

Conduct thorough eligibility checks. When you overlook potential care coverage during the pre-authorization process, you may be inadvertently leaving revenue on the table, while driving-up potential bad debt and charity care costs. A thorough eligibility and pre-authorization process ensures providers will receive the highest possible reimbursement from a patient's health plan while reducing a patient's financial burden.

Shift your focus from denial management to denial avoidance. A high clean claims rate not only keeps cash flowing, but also it can save thousands of dollars per year in paperwork costs and unnecessary time spent interacting with insurers and reworking claims. 

Keep a vigilant eye on your claims metrics. Providers who can spot inefficiencies in their claims processing will have critical insights into their revenue cycle health. They will be able to resolve problems quickly and efficiently by monitoring claims data and establishing benchmarks for claim rejections, denials and the days to final billing.

An experience end-to-end RCM outsourcing firm can offer these best practices and many more than are identified here to help your facility overcome the challenges of declining cash flows, shrinking margins and bad debt.

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

Streamline Your Revenue Cycle Management

Posted on Tue, Jun 28, 2016 @ 05:00 AM

In their May 6, 2016 newsletter, the AMA stated that: “Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is ‘healthy’ also can contribute to better outcomes and patient satisfaction.”

We couldn’t agree more!

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This has been GeBBS Healthcare Solutions’ philosophy from day one. If your practice does not have a “healthy” operating margin, you cannot have a patient care mission.

For physicians, getting paid properly for the services they provide is extremely important. Between constantly changing coding rules and dozens of insurance contracts -- each with its own coverage, billing and payment terms -- many medical practices find it difficult to keep up. As a result, physicians are too often paid less than they actually should be, which impacts their cash flow.

Following are six ways to streamline your revenue cycle and maintain your practice with a “healthy” margin to provide the best patient care possible:

  1. Pre Visit
    1. Timely Prior Authorizations
    2. Accurate Insurance and Benefit Verification
  2. Post Visit
    1. Medical Coding
    2. Timely and Effective Charge Capture
    3. Payment/Denial Posting
    4. Accounts Receivable Management

The good news is that you don’t have to take on these tasks by yourself. If you engage an experienced RCM outsourcing partner, you can accomplish all of these crucial functions promptly and efficiently, even though you may have a small internal staff. An outsourcing partner will more than pay for itself by significantly increasing your practice’s insurance payments.

Few words arouse more frustration among physicians than “pre- authorization.” And it’s easy to understand why. The time physicians have to spend persuading an insurance company to cover a medication or procedure is an expensive and annoying distraction from the task of caring for patients.

Practices with more than one location can create greater efficiencies often by centralizing the prior authorization responsibility. Putting just dedicated individuals in charge of prior authorizations for the entire practice will enable those employees to become highly skilled in the process and develop relationships with the payers.

GeBBS' centralized “Prior Auths” team effectively utilizes payer website access, and phone calls to maintain a stringent turnaround time, saving precious time and money for the practice.

With the Affordable Care Act coming into effect, the volume of self pay has been steadily increasing. The absence of proper insurance and benefit verification is the number one contributor to higher self pay balances downstream. GeBBS provides effective insurance eligibility verification services with the objective of educating patients of their copay and deductibles. GeBBS can go one step forward and collect the payments ahead of the appointment, by accepting credit card and other payment options. This drives higher patient satisfaction.

We also offer high quality coding services to assist in preventing inadequate documentation or coding errors (one of the primary reasons physicians fail to get paid appropriately for their services) by providing highly-trained, certified coders. Our team is comprised of experienced Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC) and Certified Coding Specialists (CCSs) accredited by the American Health Information Management Association (AHIMA).

Proper charge capture enables physicians to create superbills anywhere, anytime, on their PCs, tablets, or smart phones. As the charges are captured as per the system-installed CPT and ICD-10 codes, our services ensure greater accuracy, reduced chance of missed charges, and quicker initiation of the billing process. GeBBS has experience in working with all the leading practice management systems and EMRs.

Accurately recording and managing the vast amount of information associated with patient care—from account creation to payment posting—requires specialized skills and innovative technologies. GeBBS' expert data capture services are driven by our proprietary workflow application engine. This solution automates the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments, and correspondence.

Our A/R follow-up solutions can lower internal costs, increase collections, and improve your cash flow. GeBBS' expert analysts trend denials and look for patterns of deficiency that will increase your cash flow and reduce aging A/R. We specialize in enhancing the financial performance of our clients by seamlessly supporting end-to-end revenue cycle management and its related processes.

We provide access to a scalable and large pool of resources experienced in multiple practice management systems to increase your collections ratio.  Our sophisticated A/R workflow tool seamlessly performs skill-based routing. It also generates customized intelligent reports that help quickly identify and resolve unpaid accounts. Our skilled staff is trained to identify patient accounts that require follow-up and take the necessary action to collect unpaid/underpaid claims.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Offshore Medical Billing, Medical Billing BPO, outsourced medical billing

End-to-End Revenue Cycle Management Will Keep You Out of the News

Posted on Tue, May 31, 2016 @ 12:40 PM

A large Chicago-based health system recently posted an operating loss of about $186 million in 2015, nearly 15 times the amount reported in the previous year. In addition, the system will lay off 250 employees and leave 450 jobs unfilled. The health system has told its bondholders that it will write off $53 million of its accounts receivable for patient bills that went uncollected, according to a major Chicago newspaper. The CEO has attributed almost half of the system's financial losses to an inadequate collections system, which forced the hospital to write off some bills for being too old to collect.

This did not have to happen!

Revenue Cycle Management - Performance Objective

If the health system had implemented an end-to-end, comprehensive revenue cycle management (RCM) solution that includes payer credentialing and a complete billing and collection service, they could have avoided their financial quagmire. An all-inclusive RCM solution would have helped them stay on top of their Medicaid and Medicare billing, managed care plans, government-funded programs, and third-party insurances. They would have had available to them key performance metrics for accounts receivable and collections to measure their ongoing success and integrate best practices, where and when needed.

Following are just a few of the RCM solutions that could have helped this health system avoid their financial challenges.

Successfully scheduling patient flow takes thought and careful planning. It is by far one of the most challenging aspects of care delivery, but when done properly, managing patients’ schedules will increase your capacity and efficiency without increasing your overhead.

In today’s healthcare environment, especially with the Affordable Care Act, insurance and eligibility verification are absolutely critical. Identifying patient responsibility upfront prior to services rendered is critical to managing receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.

Accurate charge data entry – entering the correct patient demographics and financial information into the billing and coding systems system are also critical. In addition, validation of procedure codes to documentation and CPT/ICD coding will help avoid downstream collection problems.

Daily insurance claim submissions with claim edit corrections and reconciliation of all claims will provide an immediate boost to your revenue cycle and keep it healthy over the long run.

Proactive accounts receivable management is a must! This includes monitoring the status of all accounts and aged receivables with ongoing denial management and credit balance resolution for all applicable accounts.

And finally, outbound and inbound phone center support which includes soft collection calls, pre-bad debt management calls, self-pay patient calls, incoming billing inquiries, patient updates/payments and statement production for improved collections.

If this health system had an RCM solution, in place, like the one just described, we would not be reading about them in the newspaper.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Offshore Medical Billing, Medical Billing BPO, outsourced medical billing

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.

One way to ensure your revenue cycle remains as healthy as possible is to enlist the help of a healthcare BPO company to assist with -- or handle completely -- your revenue cyclegebbs outsourcing medical billing activities. These organizations are expert at keeping your revenue cycle fine-tuned and optimized to its maximum performance level, much like a highly-trained
mechanic can do for your automobile. There are literally dozens of advantages that third party revenue cycle companies can provide, such as onshore and offshore medical coding and offshore medical billing. Here, in my opinion, are the top 10 reasons why healthcare financial professionals should consider outsourcing.

  1. You will see an increase in your reimbursements and collections.

  2. Your labor costs for revenue cycle maintenance will be reduced.

  3. Requires no capital investment.

  4. You get immediate access to highly-skilled and expert personnel that will mitigate risks from frequently changing governmental regulations.

  5. Staff members will be freed up to work on other critical financial issues.

  6. You will receive daily, detailed financial reports upon which you can take immediate action.

  7. Your revenue cycle will be easier to track and manage.

  8. It’s an uncomplicated solution that works from day 1 of implementation.

  9. No additional staff, training or office spaces are required.

  10. You get immediate peace of mind that you are doing everything you can to maximize your revenue cycle.

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