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
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
By Nitin Thakor, GeBBS President & CEO
So far small hospitals and small health systems are not faring as well as large hospitals and health systems during the ICD-10 transition. The press is full of reports about how well the transition is going for large hospitals, but that is not the case for smaller community hospitals.
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Tags:
Business Process Outsourcing (BPO),
Revenue Cycle Management (RCM),
Healthcare Revenue Billing,
Medical Coding,
Knowledge Process Outsourcing (KPO),
Offshore Medical Billing,
Offshore Medical Coding
By Nitin Thakor, GeBBS President & CEO
According to a recent survey reported in Healthcare Finance, 83 percent of hospitals now outsource some accounts receivable and collections, 58 percent of hospitals outsource some contract management, 55 percent of hospitals outsource some denials management and 68 percent of physician groups with more than 10 practitioners now outsource some combination of collections and claims management.
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Tags:
Business Process Outsourcing (BPO),
Revenue Cycle Management (RCM),
Healthcare Revenue Billing,
Medical Coding,
Knowledge Process Outsourcing (KPO),
Offshore Medical Billing,
Offshore Medical Coding,
Outsource Coding,
Offshore Revenue Cycle Management,
Healthcare BPO Companies,
Medical Coding Outsourcing,
Remote Medical Coding
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
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
Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.
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Tags:
ICD-10,
Revenue Cycle Management (RCM),
Healthcare Revenue Billing,
Accounts Receivable (A/R),
Accountable Care Organizations (ACOs),
Affordable Care Act
The first step in determining your success with a BPO provider is to define a clear set of objectives that you expect them to meet. If you can’t define what you expect them to do, you can’t measure it. When setting your expected objectives for your BPO engagement, make sure they map to your business objectives, and don’t be too explicit. Make sure your objectives are broad enough to drive business process improvements across your entire enterprise. The next step is to ascertain your facility’s present level of performance. You must know where you are starting from if you are to measure the success at the end of your BPO journey. As part of your internal due diligence process, healthcare organizations should accurately measure their current performance to provide a verifiable base from which to develop fair and objective service level requirements for the BPO provider. Therefore, you can establish both the quantitative and qualitative standards of performance that will be required of your BPO provider.
Here are attributes of a BPO engagement to help you define your success:
- Customer satisfaction -- The most important factor to consider in a BPO engagement is, are you satisfied with your results. If you aren’t satisfied with the engagement, then no matter how many objectives were met, it is not considered successful.
- Financial savings -- BPO in many cases provides a financially compelling alternative to providing the services in-house. Most engagements identify this as a key objective. If the BPO services are not improving your bottom line, they are not successful.
- Service delivery and quality – Service delivery and quality aren't usually used in the same sentence, but they should be. Your objectives for the BPO engagement should be as specific as possible when documenting your expectations on delivery and quality. To make this a truly deliberate requirement, add a metric that tracks the number of requests you have to make for a specific service to be addressed and then document how your request was handled. This adds the quality aspect to delivery.
- Scalability to meet your needs -- Your BPO partner needs to be positioned to meet your growth requirements. An important measure of their success was how quickly they were able to ramp up their staff and skill sets to meet your changing needs.
- Stability and variability – Your BPO provider needs to provide a stable operational environment even in situations that are variable. Some of the most successful BPO ventures are with components of IT or applications that are sometimes very stable, but often provide variability that must be dealt with “on the fly.” Was your BPO vendor able to handle these situations?
- Predictability – You should expect predictability in your BPO services. Establish metrics around what you define to be “predictable” and measure your BPO provider against them.
- Competency and staffing -- Competency and staffing are strategic BPO business issues. Did your BPO partner provide competent staffing and the appropriate skill sets to meet your specific needs?
- Ability to react to changing requirements -- BPO is sometimes associated with an increase in formality, which manifests itself in the form of “red tape.” When your business requirements changed, was your BPO partner able to respond to these changes in a timely manner?
If you measure your BPO engagement against the foregoing attributes, you should be able to define your particular level of success.
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Tags:
Business Process Outsourcing (BPO),
Revenue Cycle Management (RCM),
Healthcare Revenue Billing
Today’s healthcare delivery system is at the center of many political and social debates. The ongoing focus of these debates is often how the healthcare financial process is handled, and it is one of the many problems frustrating professionals in the billing department of hospitals and medical facilities.
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Tags:
Business Process Outsourcing (BPO),
Revenue Cycle Management (RCM),
Healthcare Revenue Billing,
Medical Coding,
Knowledge Process Outsourcing (KPO)
ENGLEWOOD CLIFFS, NJ, May 08, 2013 -- GeBBS Healthcare Solutions, Inc., an industry leader in healthcare revenue cycle management outsourcing solutions, will be demonstrating its state-of-the-art coding platform, iCode, at the Radiology Business Management Association (RBMA) 2013 Radiology Summit, May 19-22 in Colorado Springs, Colorado.
Tags:
ICD-10,
Business Process Outsourcing (BPO),
Revenue Cycle Management (RCM),
GeBBS Healthcare Solutions,
Healthcare Revenue Billing,
Insurance Billing Solutions
