Medical Billing News

Texting Patients: How to Handle Communication Preferences in a Digital World

06/04/2019

It's no secret that today's generation of consumers is much different than 20 years ago (and even 10 years ago). Regardless of what we’re buying or who we’re engaging with, we want communication to be as quick and easy as possible—and preferably from our mobile devices.

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3 Ways Radiation Oncologists Can Prevent Burnout

05/14/2019

The healthcare industry is not always forgiving when it comes to workload and burnout. Long hours, high-pressure situations and continually growing administrative tasks can lead to a variety of problems: increased medical errors, low-quality patient care, higher risks for malpractice and much more.

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Why Should I Use Expert Medical Billing Services?

04/19/2019

When it comes to achieving and maintaining financial health, every medical practice needs an expert on their side to help make it happen.

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40 Years of Medical Billing Success Stories at NCG Medical

02/26/2019

Since 1979, NCG Medical has helped countless practices across various specialties with customized medical billing services that suit their specific needs. From radiation oncology and gastroenterology, to orthopedics and beyond, our team has provided many services, including practice-merger and contract negotiations, electronic health records, practice growth and much more.

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NCG Medical: Outsourced Medical Billing That Feels In-House

02/25/2019

For many medical practices, the idea of outsourcing services can be daunting—and understandably so. It’s a difficult task to just hand over all processes and trust a third-party resource that may or may not fully understand your industry. Plus, there’s also the risk that they may be difficult to get ahold of and may not have customized solutions that meet your practice’s unique billing needs.

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How to Achieve a 95% Clean Claims Rate

02/19/2019

Do you know what your practice’s clean-claims submission rate is? Because if it’s not currently 95% or above, you’ve got work to do.

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6 Ways to Prevent Medical Billing Errors at Your Practice

02/11/2019

Every successful medical practice needs a steady flow of incoming revenue to sustain business and growth. Part of that is ensuring there aren’t any billing errors causing damage to the bottom line.

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A Brief Guide to Medical Billing and Coding Best Practices

02/04/2019

At NCG Medical, our mission is to provide expert medical billing services that integrate seamlessly into your current practice management software or EHR. That’s why our team of in-house experts have a wide range of knowledge and extensive experience working with common softwares to best serve you and your practice without having to uproot all your familiar processes and resources.

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7 Reasons You Need to Outsource Your Medical Billing Services

01/31/2019

Medical billing is a standard service necessary for keeping your practice in good financial health. However, it can be difficult for in-house personnel to sustain speedy, error-free billing services in addition to the many critical responsibilities they hold. To avoid this headache of a situation, it’s important for you to consider these reasons why you may need to outsource your medical billing to a team of experts:

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NCG Medical: Experts in Your Practice Management Software

01/25/2019

At NCG Medical, our mission is to provide expert medical billing services that integrate seamlessly into your current practice management software or EHR. That’s why our team of in-house experts have a wide range of knowledge and extensive experience working with common softwares to best serve you and your practice without having to uproot all your familiar processes and resources.

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What Healthcare Revenue Cycle Management Services Are There?

01/07/2019

The primary function of every medical practice is to provide care to its patients. However, every healthcare organization also has a critical secondary function—staying financially healthy. If you’re considering outsourcing your healthcare revenue cycle management, it’s important to educate yourself on the different types of services that are available and how they could apply to your practice to satisfy your financial needs.

 

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What Is Medical Billing and Coding?

12/17/2018

With increasing demand for healthcare services and decreasing reimbursement trends from insurance companies, medical billing and coding are more important than ever to ensure proper compensation to providers. Keep reading to learn more about the details of medical billing and coding.

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How to Choose the Best Medical Billing Services for Your Practice

12/05/2018

If you’re considering outsourced medical billing services for your practice, it’s important to know what to look for before deciding on a specific solution.

For many practices who’ve never used a medical billing firm before, the idea of handing everything over to an outside source can seem intimidating, but that’s often a problem of perception. The truth is, some of the most successful practices use outsourcing services to streamline their medical practice management.

Here are a few benefits to look for when considering medical billing firms for your practice:

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10 Reasons to Outsource Your Medical Billing

11/09/2018

When it comes to thriving practices, it’s often that the in-house employees are the top contributors to that success. But regardless of talent, skill or capability, these individuals often lack the time and availability to keep up with the ever-changing tides of the healthcare industry.

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Coding Abuse: Avoiding Enforcement Actions With Common Sense Protections

11/06/2018

Submitting “clean” claims is something we emphasize here on the blog all the time – mostly in the context of ensuring forms and fields are filled out clearly for processing. But there’s another factor that makes a claim “clean,” too: Its legality.

Fraudulent claims are in the government’s crosshairs. The U.S. Department of Justice (DOJ) enforces the False Claims Act, Anti-Kickback Statute, and other laws by cracking down on coding abuse – taking aim at improperly used modifiers, overcharged services, unnecessary equipment, and so on.

That means that upcoding and downcoding can destroy your practice – and if your staff isn’t diligent about cross-checking code use, fraudulent activities on your team could pass undetected until it’s too late. Sniff out problematic coding practices on your team with these tips.

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Implementing a New Medical Practice Solution? 3 Keys to Success

10/30/2018

Has your organization decided to swap out your existing software stack for a smarter toolset? Congratulations – reaching consensus for a new solution is no easy feat (and often takes far longer than providers expect).

Regardless, deciding to switch is only the beginning of the solution implementation process. Your new vendor will undoubtedly help guide you through the experience – ideally, with the added guidance and expertise of your medical billing service. But even with the best consultative help out there, many practices still miss gaps in their approach internally.

Creating a strong sense of expectations and plans can keep your whole team engaged and on-goal throughout the implementation process. Here are our top three pieces of advice as you start putting a selected solution into action.

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What Type of Medical Billing Firm Do You Need?

10/23/2018

When they’ve never used a medical billing firm before, doctors and practice managers can be hesitant to outsource revenue cycle management. Often, it’s an issue of perception.

When billing operations are managed entirely in-house, leaders tend to believe that the practice has stronger “control” over its cash flow (even if their poor metrics prove otherwise). By outsourcing, the thinking goes, aren’t they just handing the reins over to someone else?

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5 Best Practices for Boosting Clean Claim Ratios

10/16/2018

Your practice’s ‘clean claim’ ratio is the average number of claims paid on first submission. How’s yours?

Every provider would love to reach a percentage above 95%, but it’s not really the number that matters. Practice budgets are tight, and your staff’s time is the most precious resource you have. So if your clean claims rate is less than 85% (or worse), it means your staff is likely spending lots of time on identifying denial reasons, coordinating with payers, and re-submitting claims.

That’s far from ideal. To make smarter use of resources around your practice, embrace these best practices that can help you get paid on first-submit more frequently.

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How Can Private Patient Advocates Help Providers' Performance?

10/09/2018

It was 2007 when US News first called private patient advocacy an “ahead-of-the-curve” career path serving a “huge unmet need.” More than a decade later, the role private patient advocates play in the US healthcare system is still growing – and the unmet need remains.

Private patient advocates are hired by individuals to help navigate the landscape of care. These professionals give patients an ally on their side – someone capable of applying healthcare expertise to cut through the complexities of treatment coordination and billing to help patients make fully informed decisions.

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Using Tech to Improve Patient Access & Practice Efficiency

10/02/2018

When it comes to technology, healthcare providers may feel they have their hands full meeting the requirements of incentive programs. Beyond ensuring their solutions are able to report on MIPS and MACRA and meet Meaningful Use expectations, what else is there?

Well, practices and hospitals certainly aren’t required to upgrade too much else. But failing to do so might have a damaging impact on their long-term health. As the reimbursement environment grows more value-based and consumer-driven, providers will need to more than the bare minimum with their technology.

Adhering to incentive-program expectations is only the beginning – especially because it focuses mainly on the reportability of your data, and the operability of your internal systems. Consumers, quite frankly, don’t care about that.

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Tips on Making Prior Authorizations a Smaller Part of Your Day

09/25/2018

Prior authorizations are one of the most time-consuming, onerous aspects of the fee-for-service healthcare system. Just as doctors: AMA research shows that 84% of physicians consider the burden of prior authorizations as high or extremely high.

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How to Keep Cash Payments From Tripping Up Your Practice

09/18/2018

Accepting cash payments is one way practices can broaden their revenue beyond traditional fee-for-service. For our readers in integrative health fields – such as acupuncture, massage therapy or chiropractic practice – accepting cash payments is typically a necessity (like it or not) given the challenges of insurer plans.

Still, cash-pay acceptance can create a unique set of issues for practices to deal with. And that’s true whether the need is motivated by an “actual cash” problem (that is, a need to accept full payment from patients who do not have health insurance) or an “effective cash” problem (in which insurance doesn’t cover desired services, or deductibles have yet to be met).

A few best practices can help providers handle both kinds of cash-pay concerns with confidence.

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Pursuing the Right Software Set-Up to Get Your Practice Paid Quickly

09/11/2018

Reaching the outcomes you want, in all walks of life, requires using the right tools. But in the medical practice environment, it can be hard to know if your solutions are hindering your success.

When it comes to practice management and medical billing technology, providers have a tendency to settle for systems that are “good enough” to get the job done. But doctors and their teams deserve better… and when they use better tools, they see better results.

Relying on modern, integrated solutions (as opposed to outdated, hardware-bound systems) can minimize unnecessary denials and rejections, because the best tools streamline complex onboarding processes and provide guardrails to help you submit clean claims.

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Negotiating with Payers for Better Reimbursements: 3 Tips

09/04/2018

Small practices often feel like they have no leverage with payers. But while it’s true that large practices have a lot more power at the negotiating table, independent providers should always make sure their reimbursements are paid fairly – at rates that respect the quality of care delivered.

That said, most payers aren’t trying to “stiff” small practices. They’re simply gauging economics and ROI like any other business. If you can help an insurer realize what unique value your practice brings to their table, you may be surprised at how beneficial it proves to the pay rates (or other expectations) you can secure from a payer when establishing or revising a contract.

It comes down to knowing your worth, and negotiating smart. Here are our top tips for setting rates that support your practice’s success.

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Considering Outsourcing Medical Billing? It Isn’t Always ‘All or Nothing’

08/28/2018

Medical practice professionals are resistant to the word “outsourcing.” It brings to mind ideas of offshoring and offloading – packing up your processes and shipping them off to an invisible third party (and its thousands of employees) entirely separate from the in-house team.

But it doesn’t have to be like that. And in medical billing, it tends not to be.

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Following Up on Unpaid Balances: New Tactics to Help You Collect

08/21/2018

Non-paying patients are an unfortunate practice reality. And when money goes undeceived at the encounter, the odds of collecting only go down from there.

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Should You Hire a MIPS Expert at Your Practice?

08/14/2018

The doctors and nurses in your office are experts at what they were formally trained to do: diagnose and treat patients in their specialty. Your top coders, administrators, and billers have all earned expertise in their fields, too (whether through professional education on on-the-job know-how).

When it comes to incentive program participation, however, almost no one is a true expert… which is perhaps why everyone – doctors, billers, and front desk alike – tends to think they are.

For many practices, adherence to government programs – such as MIPS, MACRA, or Meaningful Use – is an all-hands-on-deck exercise across the office, with dozens of people handing off reporting responsibilities to one another. Often, the efforts are excessively inefficient.

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Staffing to Meet Demand: Is It Possible for Your Practice?

08/07/2018

As technology delves deeper into every area of your practice operations, you may find yourself with extra resources on your hands.

Check-in kiosks in the waiting room might be freeing up staff time at the front desk, for example. Automated eligibility checks or claim-scrubbing software might be doing the same in billing. And if yours is one of the many practices embracing telemedicine (or having nurses and PAs handle check-ups and other routine visits), even your doctors might be enjoying more downtime than they used to.

It’s a welcome shift to see medical professionals get some breathing room in their schedules. For decades, healthcare’s high-touch nature has demanded ever more staff in the office setting – or worse, expensive overtime pay.

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3 Tips for Improving Your Patient Education Resources

07/31/2018

For the modern medical practice, quality content can contribute to patient acquisition, retention, and treatment adherence. Providing useful resources to patients also creates an extra touchpoint between them and your practice – helping make the relationship more meaningful.

But if your educational materials are stale and out-of-date, they provide little value to you or your patients.

If you’re still relying on that dusty rack of brochures in the waiting room, it’s well past time to improve your approach. Here’s our advice on a making your materials better.

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Best Practices for Analyzing Payer Reimbursements

07/24/2018

Do you dedicate resources to analyzing payment accuracy? Lots of practices don’t – and are putting too much faith in payers to reimburse in full on every claim they complete.

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Rethinking The Patient-Provider Relationship: 3 Insights That Can Help Grow Your Practice

06/05/2018

As a medical billing firm, we’re constantly thinking about how to help our clients improve their financial performance and get more of what they’re owed.

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The Importance of Tracking (and Lowering) Days in Accounts Receivable

05/29/2018

How well do you know your cash flow when it comes to accounts receivable? Many practices allow A/R to be a black box of misunderstanding.

Accounts receivable (the money owed to your practice for services rendered and billed) is a high-touch area of every medical practice. So if you have a large number of administrative staffers managing different patient accounts or specialties, it can be hard to gain a holistic understanding of how long it’s taking you to get paid.

That’s why many practices *think* their A/R is a-ok, even when incomes fluctuate from month to month. But if patient visits are stable, incoming cash should be too – which is why it’s vital for medical practices to understand how many days pass between the bills going out, and the payments coming in.

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Boosting Patient Retention: 3 Ways to Keep Patients Coming Back

05/22/2018

Growing your practice is a great idea, but it’s also an expensive one. It costs practices far more money to win new patients than to keep those they already have; one healthcare exec has estimated that it costs 90% less to get current patients to return for future care than it does to attract new ones.

But when you keep patients around, the benefits add up. In fact, a small number of highly engaged, loyal patients may account for the vast majority of your revenue: Across the industry, estimates say that 12% to 15% percent of a practice’s most loyal patients represent 55% to 70% of its appointments.

That loyalty doesn’t emerge out of nowhere. A patient’s likelihood of coming back is impacted by all of the interactions he or she has with your practice – spanning your office, staff, services, and general state of affairs. Here are three key ways of enhancing your odds of retaining patients.

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How Much Are Claim Rejections Costing You?

05/17/2018

How clean are your claims? According to the Medical Group Management Association, medical practices should strive for a 95% “clean claims” rate – meaning all but 5% of claims get to payers with no mistakes (and get paid) upon first submittal.

Alas, few practices reach that target. Most providers receive first-pass reimbursement for somewhere between 75% and 85% of claims they bill, and tend to see that as an acceptable state of affairs. Is it?

Every claim that is not paid on first submittal wastes a practice’s precious time and resources: The MGMA estimates that the cost to re-work a claim that has been rejected or denied ranges from $10 to $25 per bill.

That may not sound like much on a case-by-case basis, but it adds up in a big way. If you submit, say, 300 claims each month and ~25% are routinely rejected or denied, that means around 75 encounters per month need to be processed at least twice.

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What’s Next For The Affordable Care Act?

03/12/2018

At last count, about 11.8 million people had signed up for 2018 coverage through the Affordable Care Act health insurance marketplace.

The high number – amounting to 96% of 2017’s total – surprised many: Americans had a halved timeframe (compared to the year prior) to select marketplace coverage for 2018 year, and the Department of Health and Human Services (HHS) deployed a much-reduced advertising effort than in earlier eras of the ACA’s existence.

Consumers’ continued interest in accessing and buying non-employer sponsored health coverage is good news for providers, making it more likely for patients to pursue care. But is the ACA still headed for trouble? Despite the many protections “Obamacare” has received over the years, certain government leaders continue to advocate against it.

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3 Takeaways From Major HIPAA Settlements of 2017

03/07/2018

The HHS Office for Civil Rights (OCR) announced nine HIPAA settlements in 2017 – resolving allegations against a number health systems, insurance providers, and remote monitoring companies. Taken together with one additional non-settlement enforcement action (in which a $2.3 million civil monetary penalty was levied), the OCR secured over $19.4 million in fines and penalties.

The total number of nine settlements was four fewer than 2016, representing a shift in HHS’ attitude about enforcement: The OCR has said it was more eager to resolve enforcement actions informally in 2017, provided the covered entity or business associate corrected its compliance problems.

And that’s an important note to cover before we comb through the enforcement actions for takeaways, because it shows how preventable the year’s most headline grabbing settlements really are: The most commonplace security gaps of any medical practice or hospital can be filled, and settlements can be avoided if you take steps to fix them.

As we’ll run down in the three sections below, it’s largely the most egregious examples of PHI mismanagement that cost providers millions in penalties.

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CVS & Aetna Team Up: 3 Implications for Providers

03/05/2018

The proposed $69 billion merger between CVS Health and Aetna could be one of the most game-changing healthcare transactions ever: Combining the country's largest pharmacy with one of its largest health insurers will have deep and long-lasting effects on patients, providers, and payers alike.

The deal has yet to reach regulatory approval, but doctors and practice managers are wise to prepare for its impact. The two companies say the merger will to lead to better chronic disease management and an overall reduction in health care spending for Americans… which it certainly might, in the long-term.

But in the short-term, its implications for providers could be more negative. Here are a few of the potential near-term consequences.

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Is Your Technology Putting Your Practice At Risk?

03/01/2018

Sadly, some docs still believe that so long as their systems have firewalls and password-protection, they’re safe.

ted systems, practices can create undue risk by maintaining poor standards around their day-to-day use.

HIMSS and the ONC have risk assessment checklists that every practice should run through (in addition to investing in end-to-end security audits annually). But common-sense security checks are important too! By asking yourself and your team the following five questions, you can quickly get a sense of whether your technology – or the way you use it – is leaving you more vulnerable than you need to be.

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Smart Communication Tactics For Getting Paid & Reducing Bad Debt

02/27/2018

According to survey results from technology company West, 56% of patients’ payments are delayed at least some of the time, for any number of reasons.

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Why Your Practice Needs A Risk-Based Audit Plan

01/09/2018

Following the implementation of the new 60-day payback and six-year lookback requirements, it’s clear the government has higher-than-ever expectations of practices when it comes to self-policing overpayments.

But that’s far from the only area of risk facing providers when it comes to liability.

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Is Now The Time To Add Ancillary Services? 5 Questions

01/05/2018

As reimbursements shrink and incentives get harder and harder to obtain, plenty of medical practices are looking for new income streams to supplement their revenue.

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Should You Create a Sliding Fee Schedule for Your Practice?

10/31/2017

Without exception, every medical practice faces issues related to patient payments. The challenges vary – ranging from patient financial hardship to lack of insurance to high deductibles, coverage gaps, and so many more.

There’s no cure-all for a practice’s patient-payment issues, but there are a number of ways administrators can try to manage them. (One is working with a trusted medical billing firm to make sure the revenue cycle moves as smoothly as possible, with as few claims mistakes gumming up the works as possible.)

One approach seeing increased interest among providers is the idea of a sliding fee schedule, which allows you to provide discounted services based on a family’s income in comparison to the Federal Poverty Guidelines. By creating such a schedule, you can offer a financial break to both low income and self-pay patients – allowing you to minimize issues related to non-paying patients.

Before using the sliding-fee model, however, you need to consider how it will affect your practice financially and how to stay compliant with applicable regulatory guidelines. Here’s a (non-exhaustive) primer on the factors to keep in mind.

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3 New Strategies for Patient Acquisition

10/24/2017

By creating a website, maintaining a Facebook page, and keeping your online contact information up-to-date, it’s fairly easy to make sure patients in need can find and reach your practice. And by supplementing those efforts with a bit of paid advertising or search-engine-optimization services, you can be more likely to stand out online compared to competing practices in your community.

But with all of those efforts above, you’re simply enhancing your ability to be found by patients when they need you, and hoping to see them pick you over your peers. That passive approach can work, but it neglects many factors that drive patients’ choices in one direction or other.

After patients find you online, why should they select your practice over others? What makes you a better option? Why should they believe in you? Deploying patient acquisition strategies designed to drive preference, trust, and value (not just awareness) can make the answers to those questions clear to prospective patients. Here are three approaches to try.

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5 Reasons Why a Medical Billing Firm is Your Practice’s Best Ally

10/10/2017

As for any thriving business, your in-house people are your practice’s best asset. But no matter how talented and capable your personnel may be, they’re not enough to help your medical office navigate the ever-changing landscape of the healthcare industry.

Every practice needs an ally for maintaining their financial health. And while tech companies and consultants may claim that they have the cure to what’s ailing your revenue cycle or cash flow, only a trusted medical billing service can deliver the following benefits to your medical practice.

Stability That Scales

No matter your practice’s size, relying on an in-house billing team can lead to revenue interruptions related to employee absences or staffing changes. And as payers get pickier about claim filing deadlines, you can’t afford to let vacations and resignations damage your ability to maintain financial health as (or if) your practice grows to serve a larger patient base.

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EHR Implementations: What Works? What Doesn’t?

08/29/2017

In 2017, some medical practices have more experience with EHR implementations than they’d care to. After first deploying solutions around the dawn of Meaningful Use (circa 2011), many have moved on from their initial selections.

Nowadays, most EHR implementations aren’t about onboarding a practice to a digital solutions from scratch, but rather about replacing their first choice of EHR – or even re-replacing their second choice of EHR – for a better solution. But when it comes to the actual implementation process, practices that fail to heed the lessons of earlier deployments are doomed to repeat their mistakes.

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Which Medical Billing Metrics Should You Measure? 5 KPIs for Your Practice

08/15/2017

In a recent post, we called the net collection rate your practice’s most important metric. And we stand by it!

Since the net collection rate measures just how much money you receive against funds owed for services rendered, it speaks to the success of nearly every aspect of your practice.

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3 Tips for Minimizing Your Medical Practice’s Cybercrime Risks

08/01/2017

Security-, privacy-, and cybercrime-related concerns are especially problematic for medical practices. In the event of a breach or data theft, it’s not just the healthcare organization that gets affected – it’s potentially every one of their patients (not to mention their business partners, contractors, employees, and so on).

Protecting your patients’ personal data is just as important as protecting their health, but new findings suggest practices are better at the latter than the former. The most recent Benchmark Study on Privacy & Security of Healthcare Data by the Ponemon Institute found that the healthcare industry remains "negligent in the handling of patient information."

With that negligence comes an undue level of risk for cybercrime, as well as for all of the legal and regulatory consequences that can potentially come with it. Regularly revisiting your cybercrime protections can help maintain your practice’s financial well-being by keeping fines, fees, and penalties off your radar. Here are five quick tips on maintaining strong protections.

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Medical Debt Reality Check: Unpacking New Findings on Patient Responsibility

07/25/2017

Inside almost any medical practice, patient collections are an ever-present concern. Since the priority of collecting every dollar from non-paying patients can consume the day-to-day efforts of practice managers and their medical billing teams (or medical billing firms), the issue often gets outsourced to medical collections agencies.

Once a collections firm is involved, the in-house team typically stops worrying about the problem altogether and shift their attention to other things, hoping the funds will simply come in from debtor patients eventually.

But are medical practices overestimating how much they’re really owed?

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Medicare Fraud: Doctor Convicted for Multi-Million Dollar Scheme

07/18/2017

Instances of fraud in the U.S. healthcare system are anything but rare. Across the entire medical billing landscape, estimates put amount of health care expenditures lost to fraud between 3 and 10 percent.

Medicare is often perceived as a ripe target for fraud, but its rates of financial crime fall somewhere in the same range spotlighted above. While the rate is high, also an area where enforcement efforts are both active and effective: The Medicare Fraud Strike Force has a 95 percent conviction rate with jail terms averaging four years.

News of fraudulent Medicare activity only breaks when charges are filed are convictions are handed down, making it difficult to assess how much it happens among providers generally. When the big takedowns occur, in instances involving high dollar amounts, there’s usually a vast amount of collusion involved; court outcomes typically show that the fraud was a group effort carried out by a number of physicians in tandem.

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Are ‘Bankruptcy Claw-backs’ a Threat to Your Practice’s Finances?

07/04/2017

Whether it’s selecting a medical billing firm to manage the revenue cycle, minimizing your embezzlement risk with employees, or monitoring for potential cyber threats, managing your practice’s financial health is an ongoing priority. That financial health depends on income from a variety sources, including patient collections, payer reimbursements, and incentive payments (such as those for Meaningful Use), among others.

Some payment sources, however, are more problematic than others… and may even lead to unexpected losses. Two recent cases are raising the question of whether doctors should be more discerning about what income they receive, less they risk putting themselves in position to lose revenue to possible “bankruptcy clawbacks.”

What are bankruptcy clawbacks? Broadly, in the event of a Chapter 7 bankruptcy, the bankruptcy trustee (which essentially stands in the shoes of the debtor, once the entity has declared) has the right to take back any property or money that the debtor improperly gave away before filing for bankruptcy – improperly being the operative word.

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HIE Time: Why the Stock Market is Paying Attention to Medical Billing

06/27/2017

No matter the makeup of your investment portfolio, most financial experts advise everyday investors against paying heed to the day-to-day whims of the stock market. (Whereas active day traders and large firms can win profits by reacting to short-term market fluctuations, most non-professional investors benefit more from sustaining a long-term outlook and strategy.)

Nonetheless, the ups and downs of the NYSE and NASDAQ are hugely important to the health of American businesses. In addition, they have a lot to teach observers about the forces at play inside various industries – healthcare being just one.

Case in point: Of late, investors’ interest in one publicly traded medical billing and healthcare IT company has been surging. The question of why that entity is garnering so much interest is worth exploring… if only to consider how the changing share prices may signal where the future of the U.S. healthcare industry is headed – and how important the idea of information exchange is to its future.

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Modernizing Medical Billing: New Ideas Outside the Incentive Programs

06/20/2017

The U.S. healthcare system has a long-held (and well deserved) reputation as one of the most expensive, inefficient, and wasteful areas of our economy. For individual medical providers, the costs and complexities of medical billing, in particular, are so entrenched that they seem commonplace… and they also seem unlikely to change anytime soon.

Is it time for a more positive outlook among doctors and practice managers? The broad-based, government-spurred advances of recent years are beginning to make a difference at a macro level. For example, EHR use is creating better-quality billing data; HIE networks are decreasing duplicative service deliveries and improving care coordination; and the use of ICD-10 as a code set will continue to advance those benefits even further.

And while those changes have certainly been challenging for providers in terms of compliance, implementation, and education, they’ve also created new opportunities for innovation. Now that there’s a stronger, more consistent technological foundation supporting the healthcare industry at large, upstart companies and entrepreneurial doctors are aiming to improve care costs and financial efficiency without onerous government incentive programs.

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Making Patient Collections More Compassionate: 3 Tips

06/13/2017

What’s the most compassionate area of your healthcare practice? If you’re like most medical professionals, the answer is on the clinical side (as it should be).

The encounter room is the number one place where providers need to be kind and empathetic to their patients. However, it’s far from the only part of the office where those values are important.

In the back office, unfortunately, compassion can easily fall off the radar. Once EOBs and billing statements come into play, the situation changes from its focus on the physical to the financial: From the provider group’s perspective, billing disputes between patients and providers come down the numbers. So when expected patient-payment income doesn’t arrive, non-paying patients typically get sent to collections without a conversation (and the medical office lets an agency take the situation from there).

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Benefits of Bringing Physician Assistants & Nurse Practitioners into Your Practice

06/06/2017

Around medical offices around the country, a familiar waiting room refrain is being heard a little less often these days. Instead of being called once “the doctor is ready” for them, many patients are hearing “the physician assistant [or nurse practitioner] will see you now.”

Frankly, it’s about time. Physician shortages continue to be a significant issue for healthcare organizations – and with more and more patients seeking care, physicians have less and less time to spend on preventive measures and routine treatments.

By bringing qualified non-physician providers (NPPs) – namely physician assistants (PAs) and nurse practitioners – into their practices, doctors can meet their patients’ needs in a more timely and attentive manner. Physicians can also allocate their time more impactfully with NPPs on hand, prioritizing new patients, challenging cases, and specialized procedures while PAs and NPs handle less complex activities.

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Negotiating Medical Bills? Prep for More Patient Payment Conversations

05/23/2017

How does your organization feel about patient financial responsibility?

For some providers, the itemized total on an EOB is the last word – it’s essentially here’s what the payer covers, here’s what the patient owes, end of story. For others, the patient payment amount is a little less firm… and perhaps open to negotiation.

Naturally, all physicians want to receive fair compensation for their efforts (and be able to compensate their staff members appropriately as a consequence). But the question of value comes into play when or if patients take issue with the number on their invoice. Are you committed to your contracted payment rates in a hard-and-fast way, or is there wiggle room in what you expect a patient to pay?

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Should a Certified Coder be Your Next Hire?

05/16/2017

Since the implementation of ICD-10, healthcare groups have had to become far more diligent about their billing and coding procedures. Thanks to ICD-10’s increased demands around specificity, it’s more important than evers for providers to prioritize accuracy in the coding function in particular.

Even if you work with a trusted medical billing service, having smart coding minds on your internal team can help your practice achieve ongoing success in the new ICD-10 landscape (and the growing era of value-based reimbursements, ACO payments structures, and so on). If you don’t have a certified coder on staff, now may be the ideal time to bring one aboard for all of the following reasons.

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3 Ways to Improve HCC Capture for Value-Based Payments

05/09/2017

To capitalize on value-based payment opportunities, medical practices and other healthcare groups must underpin their medical billing and coding efforts with strong policies and processes that comply with VBR (aka ‘value-based reimbursement’) expectations.

HCC capture is one of those expectations. Including the correct hierarchical condition category (HCC) diagnoses on encounter claims is essential to the success of value-based payment initiatives. With the correct HCCs, your patients can be appropriately risk-adjusted (in the eyes of payers) to meet most VBR program requirements.

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Can Your Practice Benefit from Entering a Joint Venture?

05/02/2017

To stay competitive in today’s evolving healthcare market, medical practices of all sizes need to stay on the lookout for smart opportunities to broaden their business potential. What growth avenues is your group pursuing?

If the answer is ‘none,’ you should shift your priorities ASAP – and you should perhaps consider how forming a joint venture with another organization could help you achieve stronger revenue outcomes long-term.

Why Pursue a JV?

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With Healthcare Hacking on the Rise, Boost Your Digital Security

04/25/2017

As they manage the day-to-day activities of a bustling medical practice, providers and practice managers like to assume that the supporting elements of their business are running smoothly. That is, that their technologies are working effectively, their accounting measures are meeting compliance, their security measures are adequately protecting their data, and their medical billing service is managing the revenue cycle to success.

Without appropriate oversight, however, it’s very risky to assume that all is operating at optimum levels. Especially when it comes to data privacy, medical practices may not be investing in the right protective measures to adequately secure their digital information.

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5 Timely Tips for Adjusting to MACRA

04/18/2017

The Quality Payment Program (QPP) from CMS, which includes the Medicare Access and CHIP Reauthorization Act or ‘MACRA,’ is yet another step toward a more value- and outcome-driven healthcare environment than the traditional fee-for-service landscape.

Yet while QPP and MACRA represent a seminal shift, they also put providers in a ‘shifty’ situation. Right now, they need to balance the day-to-day considerations of their regular operations against the need to implement practices and policies to help them adapt to the new changes.

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How Technology Can Help Providers Better Understand Patients

04/04/2017

For many of today’s top businesses, departmental functions such as marketing and sales have become highly data-driven and technologically savvy. With the help of sophisticated technology systems, those businesses can apply a laser focus on their customer base – understanding who their buyers and users are, what appeals to them, and how they interact with the brand or company.

Healthcare hasn’t been afforded the same opportunity, and there are many reasons why. For one, our space has never been as tech-powered as many other industries. For another, it’s not privy to the same kind of one-to-one marketing and sales relationships as other sectors. Why? Because aside from preventive measures, patients pursue care when they need it; they don’t ‘buy’ it as a commodity.

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Outsource Wisely! 5 Key Questions as You Pursue a Medical Billing Service

03/28/2017

Despite the many advantages that medical practices can achieve by outsourcing their back-office operations to a trustedmedical billing service, providers and practice managers often struggle to determine if outsourcing is the right approach for their organizations.

Stakeholders’ anxieties over outsourcing can stem from variety of factors – such as their existing approach to office administration, their current financial standing, or their staff members’ mixed feelings about utilizing a third-party service. In addition, many perceive that outsourcing is akin to giving up control of the practice’s revenue cycle (and potentially losing a sense of autonomy and oversight over their income stream).

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Understanding the Most Important Updates in the 2017 CPT Manual

03/21/2017

As with every other annual edition, the 2017 CPT Manual includes many changes to the prior Current Procedural Terminology code set changes. (The manual is the AMA's official coding resource for procedural coding rules and guidelines, designed to help readers perform accurate claims submissions.)

Which changes matter most for your organization depends on your practice’s scope and specialty, since providers across the landscape of healthcare are subject to big updates for the new calendar year. All told, there are a total of 117 new CPT codes, 34 revised CPT codes, and 82 deleted CPT codes in the updated code set.

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The Changing Landscape of Medical Practice Payment Models

03/14/2017

From concierge practices and pay-as-you go clinics to accountable care organizations (ACOs) and patient centered medical homes (PCMHs), there are more ways than ever to operate your medical office from a business perspective.

Are some models better than others? In 2017, it remains hard to predict what the medical practice of the future will look like. While alternative payment models are becoming more commonplace, the U.S. healthcare and medical billing systems largely remain business-as-usual… meaning that fee-for-service still comes first.

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Medicaid Reform: The Latest Updates Your Need to Know

03/07/2017

For patients and providers across the country, the uncertain future of the Affordable Care Act (ACA) has many on pins and needles. Since 18 million Americans currently receive healthcare coverage under the ACA, any repeal or drawbacks to the ACA policies would have an immediate and complicated impact on the U.S. healthcare system.

But another potential policy initiative could impact far, far more American patients (and providers). Medicaid reform – which would affect the nearly 20 percent Americans enrolled in Medicaid – is a distinct possibility in the near future. Proposals currently circulating would reduce or eliminate coverage for millions of people.

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Staying Independent? 3 Smart Tips for Your Practice

02/28/2017

As the healthcare industry continues to evolve, becoming a hospital-owned practice is an increasingly tempting offer for many independent practitioners. Small practices that cannot afford to invest in information technology, reporting, and other population health capabilities are at a disadvantage as more of their revenue is placed at risk under performance and value-based contracts.

Having an ally on their side to navigate those issues – as well as to help them manage an ever-more complex regulatory landscape, challenging employment environment, and changing patient expectations – can certainly be an asset to struggling practices. But going ‘owned’ comes with plenty of drawbacks, too, including a lack of provider autonomy and many restrictions on how a medical office operates as a business.

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Patients as Payers? Adapting to the New Era of ‘Healthcare Consumerism’

02/14/2017

Over the last two decades, health insurance costs of have grown in ways few could have predicted, with patients now paying for a full 25 percent of their medical costs out-of-pocket. High-deductible health plans purchased through the U.S. government’s Healthcare Marketplace (following the passage of the Affordable Care Act) are far from the only reason: Since 1999, insurance premiums have risen 213 percent for family coverage purchased through an employer.

Even following so many years of increases, many patients’ deductibles, copays, and coinsurance amounts are predicted to continue to getting higher in the years to come. And the growing amount of financial responsibility being placed on the shoulders of patients is beginning to turning the traditional relationship between patients and their providers on its head.

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No More No Shows! Here's How to Promote Appointment Adherence

02/07/2017

It may seem hard to believe, but missed appointments can be the top driver of lost revenue for many medical practices. Hard data on no-shows is hard to come by, but studies generally report non-attendance rates between 15% and 30% in outpatient clinics.

When patients don’t show up, it costs your practice more than just the reimbursements on the missed visit itself. Staff time essentially goes to waste, as well, as does your spending on technological resources and other office infrastructures. Then there’s the effort plugged into rescheduling a visit, and the longer wait times imposed on your patient base unnecessarily – potentially leading to lower overall satisfaction rates.

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The Top 3 Medical Billing Issues to Watch in 2017

01/31/2017

With the new year underway, there remain a multitude of question marks for medical billers and other members of the U.S. healthcare system. As 2017 marches onward, organizations need to continually pay mind to the trends, issues, and updates that will affect the effectiveness of their revenue cycle over the course of what is sure to be an eventful year.

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How to Embrace 'Fiscal Stewardship' in the New Era of Healthcare

01/24/2017

In the day-to-day management of a medical practice, the most important concern is (and always will be) patient care. But in the evolving landscape of U.S. healthcare and medical billing policy, providing responsible care involves considering far more than the effectiveness of treatment plans, prescriptions, and preventive services.

Following decades of arguments and advocacy, the landscape of healthcare is shifting ever closer to a fully performance- and quality-driven future. From the MIPS, MACRA, and Meaningful Use incentive programs to the embrace of ACOs, collaborative care models, and pay-for-performance and outcomes-based fee schedules, there’s an increased focus on the financial side of healthcare... a focus that affects both patients and providers.

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3 Timely Tips to Keep Denials from Decreasing Your Income

01/17/2017

The start of a new year is a wise time to revisit some of your practice’s most important metrics around financial health. Denial rate is one of the most significant indicators of your medical billing success – but unfortunately, it’s one of the most difficult elements of your billing operation to improve.

Denials eat up an estimated 3-5 percent of providers’ overall revenue (though for some practices the number is much, much higher). Denial rates between 5 and 10 percent are considered ‘average’ across the industry, but many practices experience rates far closer to 20 percent – often, without even realizing it – even though an estimated 90 percent of denials are preventable, and many can be easily reimbursed if practices follow up appropriately.

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3 Ways to Stay Out of Hot Water for 'Surprise' Medical Bills

01/03/2017

When it comes to hot-button healthcare issues, the problematic prevalence of balance billing is near the top of the list. Consumers have been decrying the practice for decades – and regulators are (finally) raising a flag at the high amount of ‘surprise’ medical bills being sent to patients around the country.

As most medical billing professionals already know, patients can be caught off guard when they receive statements requiring them to cover the difference between the cost of a given service and the amount an insurer has agreed to reimburse for that service. In instances in which patients receive care from an out-of-network physician, the charges can be (in the eyes of patients) excessively or unnecessarily high.

Increasingly, it’s hard to argue with patients’ perspective. Among providers, high rates of ‘surprise’ medical bills are often blamed on the growth of high-deductible insurance plans built around small networks of health-care providers but those ‘narrow networks’ may not be the real issue: A study recently published in The New England Journal of Medicine found that many patients are being hit with big out-of-network bills even when they take care to go to hospitals that their insurers considered in-network.

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Smart Strategies for Managing Your Practice's Online Reputation

12/27/2016

NCG is committed to helping customers improve medical billing performance to help achieve profitability and practice success. But in today’s healthcare landscape, practice profitability involves a lot more than just the revenue cycle.

To improve financial performance over time, medical offices need to grow or expand by adding new individuals to their patient base. The primary way to do that in 2017 is to maintain an appealing, attractive online presence that aligns with your practice as a business.

In fact, appealing to online audiences is important even if you’re not currently accepting new patients. Ultimately, you want all external constituencies to see your practice as an ideal place to receive care. But maintaining a marketable online presence isn’t always easy, and it gets more and more difficult every month.

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3 Strategic Planning Tips for Your Practice in 2017

12/06/2016

2016 has been a tumultuous year across the healthcare space: With new changes coming down the pike thanks to programs like MIPS and MACRA – and the impact of the ICD-10 transition still reverberating through the medical billing function – medical practices have faced down a lot of challenges this year… and are ending 2016 on a note of uncertainty, as well.

With a new administration on the way to White House, doctors, administrators, and medical practice managers are bracing for the impact of any forthcoming changes to Medicare, Medicaid, and (of course) the Affordable Care Act. But in the meantime, providers can’t just hold their breath and wait for change – it’s all about moving forward!

As our industry awaits what will certainly be a game-changing 2017, it’s important for provider organizations to invest in establishing strategies to achieve success in the year ahead. As you make strategic plans for your practice this winter, keep the following pieces of advice in mind.

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The Link Between Patient Engagement & Reimbursement

11/08/2016

Especially in the increasingly value-based landscape of medical billing, boosting patient engagement levels is a priority of most modern medical practices. But even for those organizations that have yet to embrace the shift to quality over volume, patient engagement remains far more valuable from a financial perspective than most organizations realize.

Given the growing infiltration of consumer-driven technology in healthcare – mobile devices, for example – doctors understand that connecting to existing patients using digital technologies can boost overall satisfaction. According to a recent study, there’s greater alignment on engagement than ever before: Now that 76 percent of patients say technology has the potential to improve their health, 84 percent of physicians believe patient engagement is beneficial.

Undoubtedly, it is. Technologically engaged patients have 15 percent fewer hospital readmissions than their peers, and experience 17 percent fewer medical errors (creating savings for doctors from a legal liability standpoint).

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Is Your Tech Ready for MACRA? Time to Find Out

11/01/2016

In the increasingly value-based world of healthcare, providers’ success will hinge on their quality of service – not their fees and volume. The latest driver of the “value-first” evolution is MACRA, or the the Medicare Access and CHIP Reauthorization Act.

MACRA has been a hot topic across the healthcare space since earlier this year: On April 27, 2016, CMS released the proposed rule for MACRA, which repealed the wildly unpopular Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaced it with a new value-based reimbursement system called the Quality Payment Program (QPP).

The QPP consists of two tracks: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). On October 14, the CMS released the final rule to the implementation of MACRA with several important changes to QPP – one of which being a change to the weighting of the different measures used to determine payment adjustments under MIPS (quality, resource use, advancing care information, and clinical practice improvement). The final rule designated 2017 as a transition year in which resource use will not be included in the reimbursement calculation; quality will comprise 60% of the composite score in 2017, instead of the proposed 50%.

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Thinking of Joining an ACO? 5 Things You Need to Know

10/11/2016

Over the last few years, accountable care organizations or “ACOs” have taken off throughout the U.S. As of the end of January 2016, Leavitt Partners had identified 838 active ACOs with service in all 50 states and the District of Columbia… which means no matter your geographic location, joining an ACO is an option available to your practice.

Broadly, an ACO is a group of providers (hospitals, practices, and/or other healthcare systems) that agree to work together toward collectively improving the quality of care they deliver to patients, while at the same time working to reduce patients’ overall healthcare costs. Under government initiatives such as the Medicare Shared Savings Program, ACO participants that meet various quality and cost-savings objectives can share in the cost savings achieved overall – making it the first care delivery model that allows physicians to see tangible financial benefits from provided well-coordinated care to their patients.

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How to Keep Costs Down in an EHR Implementation

10/04/2016

Even as the healthcare industry grows more and more driven by – and welcoming of – technological change, there are plenty of doctors holding onto their paper-based processes for as long as they can. The hardest thing to give up: Those trusted manila-folder medical records.

Though the industry-wide shift to electronic health records was incentivized by the U.S. government through the HITECH Act (and its Meaningful Use criteria), many doctors didn’t see the HHS’ financial incentives as compelling enough to make the switch. It’s easy to understand why: EHRs can be notoriously difficult to use, involve lengthy implementation timelines, require employees to learn new processes and tools, and are typically – most importantly – very, very expensive.

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3 Surprising Consequences of the Shift to ICD-10

09/06/2016

Following years of arguments, delays, and controversies, the shift to the ICD-10 code set has gone relatively smoothly since its mandated transition date of October 1, 2015. Almost a year later, the code set’s full implementation is almost upon us: On October 1, 2016, the ICD-10 “grace period” comes to an end.

What does that mean? Namely, that the “unspecified” use of an ICD-10 code, minus the most specific modifier, will no longer be A-Okay under the Medicare guidelines. (For example, medical practices today can still leave it unspecified whether they’re treating an injury on the left ear or right ear when selecting an ICD-10 diagnostic code for the bill. At present, that’s not reason enough for a claim denial. Come October 1, it may be.)

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Can a Practice Management Organization Help Your Practice?

08/09/2016

Amid the evolving health insurance market, many providers are facing down a choice: indemnity versus managed care.

Of course, doctors aren’t required to pick one or the other. But with managed care plans on the rise now that many consumers are responsible for a greater portion of their individual care costs, most practitioners that want to earn revenue from managed care patients have little choice but to buy in to a physician-hospital organization (PHO) or sell out to a larger group or hospital.

But a third option is out there. By working with an MSO, or management services organization, providers can essentially straddle the line between the independent and dependent options for operating a practice.

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3 High-Cost Healthcare Trends to Watch Out For

08/02/2016

According to the latest projections from the Centers for Medicare & Medicaid Services, U.S. health spending will rise nearly 6% for the next 10 years. That’s not necessarily directly due to healthcare-industry developments – in fact, a significant portion of the uptick will stem from economic growth and population aging – but with health spending poised to increase at a pace 1.3% greater than the gross domestic product, external forces will certainly play a role in rising costs.

What problems are putting spending on the rise to come? At NCG Medical Billing, we see the following three as having the heaviest impact in the years ahead – and we suggest you utilize an outsourced medical billing service to keep them from wreaking havoc on your practice’s bottom line.

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A Case of the MIPS: Preparing for the Newest Quality Reporting System

07/26/2016

Another year, another new healthcare development, another new acronym. This time it’s MIPS – the CMS’s new Merit-based Incentive Payment System, which will have its first performance year in 2017.

To catch you up to speed: On April 27, 2016, CMS released the proposed rule for MACRA which repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two tracks: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).

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Maintenance of Certification: 5 Questions on the Value of MOC

06/28/2016

If you’re looking to start a contentious discussion among pediatricians or internal medicine practitioners, bring up Maintenance of Certification (MOC) – one of the most divisive issues facing specialists today.

To bring you up to speed, the nature of specialist physician certification changed just over a year ago: Whereas passing their certification boards was once an optional “feather in the cap” stamp, it has now become more of an expensive, time-consuming requirement for many doctors employed in large hospitals and health systems.

Why? Because some health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities, and the windows on how long the certifications keep shortening (from ten years, to 7, to 5 in some specialties). Because earning MOC credentials requires taking closed-book exams – often on topics unrelated to their speciality, such as the “hand washing module” – they require a lot of burdensome prep in exchange for little value in return.

Reforms are underway: Oklahoma recently became the first state to remove maintenance of certification requirements for physicians, and other states and physician groups are actively advocating against MOC, because there are more reasons the program is problematic than just the inconvenience involved. Here are a few.

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Digital Patient Engagement: How it Affects Revenue Cycle Management

06/07/2016

As the healthcare industry continues its shift toward outcome-driven care and value-based payments, practice-payer collaboration is key to revenue cycle success. But with so many payment-related and regulatory concerns to account for – from PQRS reporting and incentive program requirements to weighing the benefits of joining an ACO – it’s important for every provider to ensure that patient satisfaction remains a top priority.

Thankfully, however, the continuing digital transition across the healthcare ecosystem presents myriad opportunities for doctors and medical practice managers to better engage patients. And it’s important for providers to embrace the digital engagement opportunity: With more choice and transparency available to them, more and more individuals are feeling empowered to take control of their personal health… and if they’re not fully satisfied, that can often include switching doctors.

In the new landscape of healthcare and medical billing, digital patient engagement impacts on medical practice revenue in three key ways: Choice, convenience, and care.

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Waiving Your Way into Trouble – Writing Off Patient Co-Pays Is Costly

05/31/2016

Freebies and discounts are a time-honored American business tradition. In many industries, throwing in something “on the house” is a sound marketing tactic or a built-in aspect of business as usual (at least for mattress salesmen waiving the cost of the bed frame when you buy the deluxe model, or for lawyers and accountants who usually charge $120 an hour, “but in your case…”).

Doctors, however, aren’t privy to such strategies. In the old days of medicine (before the institution of health insurance in the U.S.), it was normal for physicians to discount their services or waive patient costs at their own discretion. The physician’s intent – whether to assist a patient who’s struggling financially, to provide a professional courtesy to another MD, or simply to do something nice – was irrelevant.

But that world of free-for-all freebies is a relic of the past. Due to the involvement of insurers in the medical billing and revenue cycle process, the physician’s intent when offering something gratis is very relevant – and very hard for insurers to make peace with. It may seem like a harmless favor to waive a patient’s financial responsibility for a given encounter, but it’s actually anything but.

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Note Language & Denials: Using Precise Documentation to Avoid Delays

05/24/2016

Note language is an aspect of the practice of medicine that bridges both the administrative and clinical sides of the house. As a responsibility, documentation falls on the priority lists of practitioners – doctors, physician assistants, or nurses. Yet the consequences of providers’ documentation decisions fall on their support staff of coders and medical billers, whose job is to get practices paid by insurers.

Note language is the ‘connective tissue’ between the patient encounter and the revenue cycle. Even for those physicians who are heavily reliant on charge tickets (or other forms and technology tools designed to make it simple for back-office teams to code an encounter), note language serves to guide diagnoses, treatments, and care coordination – and it’s vitally important in the event of any audits, quality reviews, or patient file requests.

Yet despite its significance to both care outcomes and the revenue cycle, many providers don’t adhere to best practices in the space. (If you’ve ever perused a selection of charts, you’ve probably seen a few eye-raising notes yourself.) Especially now that ICD-10 requires greater specificity in coding, precise and accurate note language is a medical practice’s best hedge against claim denials and delays due to resubmission.

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Choosing a New PMS? Consider its Impact on Medical Billing

05/17/2016

Upgrading from a legacy practice management system (PMS) to a more modern solution can be hugely rewarding for providers, but it’s not without its challenges. Like all technology purchases, selecting a PMS vendor is a time-consuming process that can be riddled with system limitation issues and frustrating negotiations.

But the key to successfully choosing a new PMS is understanding – up front – what you need and want from a new system. There are a million factors to consider and questions to ask: Can it integrate with your electronic health record system and/or patient portal? Does it require a lengthy installation process? Does it offer check-in functionality or other administrative features?

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Simplification & Consolidation Will Lead To Efficient Medical Billing

05/10/2016

A wide-ranging national discussion of ‘reforming’ (or otherwise improving) the American healthcare system has been loud for years – and thanks to our current election cycle, it’s reached a higher decibel level than ever.

Conversations about expanding U.S. patients’ coverage, changing (or overturning) the Affordable Care Act, and implementing universal Medicare (or a lesser “public option”) are dominating American newswaves. Like ‘em or not, the candidates have lots of people talking about what kinds of changes to the system are best for American healthcare consumers.

But amid our nation’s collective focus on improving healthcare for the benefit of patients, we forget that patient-centered improvements will also benefit providers. The inefficiencies of the current system don’t just cost patients money; they weigh down hospitals and medical practices with expensive responsibilities, outdated expectations, and high administrative costs.

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New OCR Guidelines Help Providers Navigate the HIPAA Privacy Rule

05/03/2016

In many practices across the U.S., “HIPAA” is a term thrown around often. Providers and administrative staffers carefully protect patient records out of over-concern, at times cracking wise about the “HIPAA Police” coming to get them for violations.

It’s a joke, of course, but it stems from genuine caution. The HIPAA (aka the Health Insurance Portability and Accountability Act of 1996) Privacy Rule is designed to protect the privacy of American healthcare consumers by shielding their personal health information or “PHI” from unauthorized eyes. The consequences for not doing so can be devastating; headlines about HIPAA violations abound every quarter, with six-figure fines becoming ever-more commonplace. (Multimillion dollar fines, stemming from large data breaches, have also been imposed.)

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CMS Releases Proposed Rule on MACRA Implementation

04/28/2016

Yesterday the Centers for Medicare and Medicaid Services (CMS) released its anticipated proposed rule which details how the Agency intends to implement the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) Medicare reimbursement methodologies which will replace the Medicare Sustainable Growth Rate Formula (SGR).

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which is the legislation responsible for creating these new systems, outlines the broad framework for how they will function but left it to CMS rulemaking to develop the granular details for how these new Medicare reimbursement methodologies will function. Specifically, this 1,000-page document proposes the criteria, definitions and other key details that are necessary for implementing MIPS and APMs. CMS will solicit and consider stakeholder comments before issuing a final rule before the end of the year. So stay tuned for further analysis and updates.

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How Better Transparency Can Bolster Medical Billing

04/26/2016

From inside the healthcare industry, providers and their medical billing teams have a framework for understanding of how the billing process works. From outside, however, it’s an entirely different story. Both insured and uninsured patients face huge challenges navigating the business side of the American healthcare system – in part because few have the luxury of thinking about the “business side” when their need for care arises.

Many patients only pursue treatment when facing emergencies, illnesses, or recurring healthcare issues, making it hard for them to think ahead to budgeting and planning for potential costs. Even as the industry pushes for a greater focus on primary care, most Americans’ engagement with the healthcare system is reactive – either to their physical needs or their doctors’ orders.

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The 60-Day Rule: Understanding the New Requirements for Overpayments

04/19/2016

The Centers for Medicare & Medicaid (CMS) services has done its fair share of confusing people, but a proposed rule issued back in February 2012, under Section 6402 of the Affordable Care Act, may take the cake as its most cryptic communique ever.

The rule required providers and medical billing teams who discover an overpayment to refund it within 60 days, or else be considered to have made a "false claim." In the context of the rule, an "overpayment" referred any funds received or retained under the Medicare or Medicaid programs to which the recipient was not entitled – dollar amounts be damned – even if the claim was not known to be false at the time of submission.

Hypothetically, the proposed rule could put a provider at the mercy of the False Claims Act for accepting just a few dollars too many on a given reimbursement (even if it resulted from Medicaid’s or Medicare’s error). But the what-if-it’s-just-a-few-pennies issue pales in comparison to the larger question posed by the proposed rule: Within 60 days of what, exactly?

The CMS took its time to clarify the answer, finally issuing guidance (as we’ll explain below) in February 2016. But even before the CMS did so, providers were held to full compliance with the requirement – whether they understood it or not.

Now that the Final Rule has (finally) been issued, we’re here to help you understand it. Here’s what you need to know.

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Spring Cleaning at Your Practice: Optimizing Tasks & Workflows

04/12/2016

With April well underway, we’ve entered the season of renewal. Just as April showers bring May flowers, practice improvement efforts in April can reap positive impacts over the rest of the year.

Make this that year that your medical practice’s “spring cleaning” goals cover more than just purging the fridge and reorganizing your office. It’s wise to invest in optimizing operations across your medical billing, administrative, and practice management concerns now; April not only launches Q2 2016, it kicks off the cyclical seasonality of most medical offices: Once your staff comes back from any Spring Break travels, they’ll only be in-office (and all-hands on deck) until their Summer plans pull them away again. As soon as you staff back up to capacity, a busy Autumn will pass in a flash before the pressure-filled holiday season is upon you.

In sum, now is a great time of year – and perhaps the only time of year – to make positive changes happen on the business and patient-service sides of your practice. Here are our tips on driving better efficiency and outcomes in each area of your operations.

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Will 2016 be the Year of the Patient Advocate?

04/05/2016

While it’s unfair to make broad generalizations about physicians as a demographic, it’s safe to say that doctors (almost always) tend to believe they’re right. Whether due to their extensive educations or the oft-decried “god complex,” it’s no dig to say that doctors see themselves as harbingers of good judgment – the best judgment – when it comes to all things patient care.

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Billing for Telemedicine: The Tips You Need to Know

03/29/2016

Telemedicine is an excellent advancement for the healthcare system at large, since it helps underserved communities get the medical attention they deserve even when a local physician is unavailable. But despite the growing prominence of “telehealth” across the landscape of care, medical billing for it is still tricky business.

Medicare, Medicaid, and commercial payers all have different rules when it comes to billing for telemedicine, many providers who offer tele-services rely on a cash-pay-only approach. As such, there’s no set of one-size-fits-all advice for providers looking to grow their telehealth services list – but the following tips may help you navigate the evolving reimbursement environment without incurring issues.

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Navigating Tax Time at Your Practice: Don’t Miss These Tax Deductions

03/22/2016

Running a medical office is an expensive effort. It’s a labor of love, of course, but a costly one – with a million different kinds of practice expenses falling into dozens of different accounting buckets.

But with so many expenses come many opportunities for tax deductions – even among the smallest drops in each bucket. But in the day-to-day operation of a medical practice, many deduction opportunities are inadvertently overlooked.

Hopefully your practice has a trusted tax attorney and/or CPA on hand helping you navigate tax time (and if not, we encourage you to find one). But as you file your returns this year, we encourage you to keep an eye out for every possible deduction, including those in our (non-exhaustive) list provided below.

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Can ‘Automated Intake’ Help Boost Medical Practice Performance?

03/15/2016

As technology increasingly infiltrates every aspect of medical billing, patient care, and practice management, one piece of day-to-day medical office operations has been largely spared: check-in. Even many technologically savvy practices, clinics, and hospitals still handle patient arrival with the same tools they always have – a printed paper sign-in sheet and clipboard-bound ink pen.

But despite its ubiquity, the paper-and-pen check-in experience poses obvious drawbacks. For one, it’s an inefficient process since there’s obviously more involved in intake, from an administrative perspective, than just patient sign-in. Secondly, it’s not at all private; the names of patients may be crossed out in permanent marker once the front desk staff enters their arrival into a practice management system, but that’s hardly a foolproof privacy-protection strategy.

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Tips for Success in the New World of Patient Collections

03/09/2016

Change is a constant in medical billing and practice management – and Q1 2016 has had change to spare: Meaningful Use is in transition; the impact of ICD-10 is still reverberating; and new programs like MACRA are still making their debut. But as regulators and industry overseers like the HHS and CMS deploy new mandates and guidelines to make sure providers don’t get set in their ways, many back-office aspects of the healthcare business remain stuck in the past.

Take patient collections, for example. Given that even the most efficient medical practices often put unpaid balances on the back burner, collections is an area where providers rarely invest much effort adapting to changing patient expectations or embracing new ‘best practices.’

But that shouldn’t be the case. High-deductible health plans continue to rise in prominence, making patients responsible for far more out-of-pocket costs than they used to be: From 2003 to 2013,

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Insurers Facing New Pressure on 'Doctor Directories'

03/01/2016

It’s a scenario medical billing professionals know all too well: A patient mistakenly believes a provider is in-network for his insurance and is stunned upon receiving a bill replete with out-of-network charges. What ensues next varies – the dispute gets animated; the bill goes unpaid; the collections department gets involved – but it’s never a good situation, for the patient or the medical billing company (or in-house team).

But thankfully, that scenario may begin happening a bit less in 2016. Regulators have wised up to the fact that patients are often trusting more than just their judgment when it comes to choosing a doctor: Insurers often post online doctor directories to help patients know which doctors are in-network for the health plans. The only problem:

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Is Mobile Texting a Do or a Don't in the Healthcare Environment?

02/23/2016

From employees texting bosses to business owners texting customers, many of the unwritten rules and tentative boundaries that once defined who, and what, accounted for “appropriate” texting behavior have largely fallen away. Overall, that’s a welcome development for most folks who find the convenience, clarity, and quickness of texting preferable to voice-to-voice conversation.

But the healthcare system is a somewhat different story. Mobile texting’s rise in the world of hospitals, medical offices, and medical billing companies has been shakier than in many other industries, thanks to valid, worthwhile concerns over patient privacy and the sensitive nature of healthcare information at large.

Even if your healthcare establishment has a highly limited relationship with texting (i.e., it’s “frowned upon,” or only used for patient reminders and alerts), it’s worth revisiting what is, and isn’t, ok when it comes to texting among doctors, patients, and staff. Keep the following tips in mind whenever you unlock your smartphone to ping someone in your medical practice’s orbit.

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3 Best Practices for Patient-Friendly Medical Billing Statements

02/16/2016

The shift toward a more consumer-driven healthcare environment has impacted nearly every aspect of patient care and medical practice management. In the short period of time since U.S. healthcare reform ‘took off’ around 2011, hospitals and medical offices have grown accustomed to many new norms: care coordination and value-based payments; Meaningful Use and quality reporting; self-purchased patient insurance; and primarily paperless revenue cycle management (RCM) processes.

A consumer-focused healthcare system is designed to put patients’ wants, needs, and care at the center of the entire healthcare experience. Yet there’s one area in which patients are continuing to cry out for more clarity:

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Not So Fast: The End of Meaningful Use Isn’t Imminent After All

02/02/2016

Many healthcare industry stakeholders thought they got a belated Christmas gift on January 11, when Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), announced that the Meaningful Use program would “now be effectively over and replaced with something better.”

Given the EHR incentive program’s disfavor across the industry, you could almost hear the cheering in hospitals and medical offices across the country. But celebrations of the ‘end of meaningful use’ were shortlived: Just eight days later

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Patients or Payers – Which Come First at Your Practice?

01/26/2016

A high-functioning medical establishment – like any other business – should ideally operate like a well-oiled machine. Your office policies should be clearly defined, your staff should be trained to follow them, and your employees should be motivated to execute their responsibilities in line with expectations.

And nowhere should those expectations be more clearly defined than when it comes to dealing with insurers. Ever-changing and illogical as they sometimes may be, payers have nothing but medical billing rules. Working with payers successfully requires your practice to adhere to rigid guidelines, so making sure your staff knows, understands, and follows those guidelines is vital to your bottom line.

Maintaining and enforcing office-wide policies about payers’ is undoubtedly a huge part of your HR program. But what happens when payer rules collide with patient care?

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ICD-10-Produced Problems: How to Manage the Ongoing Impact

01/19/2016

After all of the industry-wide infighting and regulatory postponements that marked the years leading up to the mandated shift – at long last – to exclusive use of the ICD-10 code set, the implementation phase has finally passed. And despite the extensive bickering and delays, the switch ultimately went by with less of a bang than a whimper.

How individual healthcare-sector stakeholders feel about ICD-10 depends, naturally, on their role and personal experience with the shift. But overall, results are fairly positive: 79 percent of responding organizations to a KPMG survey reported a successful ICD-10 transition since October 1, 2015.

But medical billing professionals may not be entirely out of the ICD-10 weeds just yet. (And we’re not talking about those in the 11 percent of organizations that told KPMG their transition was a “failure.”)

“Organizations are beginning to see dips in cash flow due to payers delaying the processing of ICD-10 claims while they ensure their ability to appropriately adjudicate these claims,” says Craig Greenberg, KPMG director. “Others are seeing an increase in claim denials over pre-ICD-10 levels.”

Others predict the impact on organizations’ revenue is yet to come, believing that the specificity in the data provided by the new code set will lead insurers to lower the prices they pay based on the severity of the diagnosis code.

Either way, hospitals and medical practices are wise to stay alert to potential ICD-10-produced problems. Here are our tips for staying on top of the new code set’s ongoing impact.

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Medical Billing in 2015: 4 Takeaways from the Year that Was

01/12/2016

Before launching into the new year, it’s important to reflect on the developments and trends that made medical billing in 2015 so important to the healthcare industry at large!

It’s been far too eventful a year to cram into a brief “year in review,” but in looking back it’s clear these four stories marked the most significance for medical billers, coders, and practice managers over the last twelve months. Plus, we predict they’ll continue to reverberate loudly in 2016 ahead.

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Boosting Practice-Payer Collaboration in 2016

01/05/2016

Happy New Year! With the dawn of 2016 comes the annual ritual of resolution – personally and professionally. A new year presents a new opportunity for improvement at your medical practice, particularly when it comes to how well you play with others.

Which others? Your payers. Solid payer relations can make a huge difference to medical practice performance, and not just when it comes to bottom-line medical billing concerns. If frustration over processing times, exorbitant fees, improper denials, or underpayments plagued your practice in 2015, it likely spilled over into aspects of managing your practice. Practice-payer issues can decrease employee satisfaction, or even lessen the quality of patient care – making it vital for you to face issues head-on, rather than let them fester.

Seize the new year strong by spending some of January improving payer relations. Prioritize getting treated fairly; while you’ll never earn everything you hope to from insurers, following the steps below can help you get more of what you rightfully deserve.

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Is Medicare Going Broke? 3 Trends to Watch

12/29/2015

When President Johnson signed Medicare into law on June 30, 1965, he said: "If it has a few defects, I am confident those can be quickly remedied." Quickly is a relative term… but more than fifty years later, more than a few defects remain.

The death knell and possibility for Medicare going broke and its sister program, Medicaid, has been sounded regularly for decades by politicians, government entities, and special interest groups alike. Their claims that Medicare is headed for bankruptcy are largely overblown, but they’re not entirely without merit: Healthcare spending overall has decreased in recent years, but in 2014 Medicare spent over $613 billion to cover care for 54 million beneficiaries. Projections of Medicare costs are highly uncertain, especially when looking out more than several decades, so it’s likely that the program will continue to eat up an ever greater portion of the federal budget and the economy.

Even more concerning may be the structural flaws leading the program to misallocate and misuse funds. A recent Government Accountability Office report found that $60 billion (10 percent of Medicare's budget) was lost to waste, fraud, abuse or improper payments in 2014.

Beyond that misspent 10 percent, however, what’s plaguing the Medicare program moving forward? What forces will have the greatest impact on Medicare’s solvency in 2016 and beyond? For any healthcare group, revenue cycle management entity, medical billing company, or Medicare-covered patient interested in the future of the program, these are the top issues to keep an eye on.

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Balance Billing: Why It's Coming Under Scrutiny

12/22/2015

The “first do no harm” dictum for doctors has at least one exception: the wellness of their patients’ finances. Nowhere is that more apparent than in the least welcome surprise patients face in the U.S. healthcare system - the unexpected medical bill, typically delivered courtesy of one all-too-common practice: “balance billing.”

As many medical billing professionals know, balance billing is what happens when a physician bills the patient for the balance of a fee beyond what the patient’s insurance paid. It happens most problematically when

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Open enrollment is Upon Us. How Should You Handle It With Patients?

12/14/2015

Open enrollment is upon us once again. How can two simple words create so much complexity?

Every November-December, medical practices, insurance companies, patients, and medical billing services face down healthcare’s least favorite season - and every year it seems to get more challenging for all parties involved. Just how challenging? In a recent survey of 400 adults who purchase their own health insurance, ConnectedHealth found that more than half of those polled felt choosing a health plan was more complicated than solving Rubik’s Cube.

Depending on their employer coverage or familiarity with the Affordable Care Act and the state and national healthcare exchanges, your patients may see your practice as their only resource for navigating the complexity of open enrollment. But given that patients and providers have far different financial concerns, that’s a tricky spot for practices to find themselves in. What should, and shouldn’t, you say?

The key to assisting your patient base through the open enrollment rigmarole (without compromising your ethics) is to stick to providing fact-driven information, and to stop short of telling patients which plans to pick. Here’s what we suggest:

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Fee-for-Service / Private-Pay: Physicians Grapple With Changing Models

12/08/2015

From low reimbursements to high deductibles to non-paying patients, doctors and medical practice managers have plenty to be frustrated about when it comes to the business of healthcare. Yet interestingly, their chief complaint has little do with earning less money than they deserve – it has to do with the trouble they go to in order to get it.

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Vendor Allies: The Partners Who Help You Optimize Payment Performance

12/01/2015

Amid dwindling reimbursements, ICD-10 challenges, and the rise of high-deductible health plans, medical practices are increasingly pulling away from payers. Some are switching to concierge care, others are testing the waters with self-pay patients and rate-card pricing, but almost all physicians and medical practice managers are expressing frustration at the changing healthcare landscape.

The challenges of working with insurers are well-documented, and many of the practices trying new approaches to payment are doing so with success. But what’s a practice to do if it’s not interested in changing its model? Cutting payers out of the revenue cycle is a non-starter for many traditional medical practices and healthcare groups – especially those with small or aging patient populations.

How do you optimize revenue without making a major change to the structure of your medical practice? By leveraging the power of vendor allies.

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Using Patient Satisfaction Surveys to Boost Practice Performance

11/24/2015

In our experience as a medical billing company, doctors and practice managers are often hesitant to treat their patients like customers – or to refer to them as such. To some it feels unethical to view a patient encounter as a transaction, since it can lead to seeing patients as an income stream rather than as human beings seeking care, treatment, and outcomes.

Yet the practice of medicine is also a business, and leading any revenue cycle management stream to success requires a strong focus on customer service and satisfaction. Assuming patients’ loyalty will breed their retention is no longer an option: With U.S. healthcare patients growing increasingly responsible for the costs of their own care, it’s more common than ever for patients to “shop around” for doctors and price-check recommended procedures and treatment plans from provider to provider.

Ultimately, the only way to keep your patients coming back to your practice is to make sure they’re satisfied with the experience they receive from you. That experience is about far more than just the patient-provider relationship and the effectiveness of a given course of care; it includes patients’ perception of your office, their interactions with your staff, and dozens of other factors ranging from scheduling availability to the reading materials in your waiting room.

Don’t assume that just because your patients aren’t complaining, they’re happy. The only way to truly know how satisfied your patients are is to ask them directly and often. The Medical Group Management Association (MGMA) has found that over 60 percent of “better-performing” medical practices regularly use patient satisfaction surveys to measure, evaluate and improve their operations.

Is your practice “better-performing”? Or could it perform better? Distributing surveys, and acting on the results you receive, is the only way to find out.

The knowledge of the patient’s opinion of his experience in your office is invaluable. It is, in many ways, just as important to the success of the practice as a correct diagnosis is to the health of the patient. If used properly, the patient satisfaction survey can truly serve as a diagnostic tool for the practice.

To make your surveys the more effective follow these best practices:

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The New Meaningful Use Rules: What You Need to Know

11/20/2015

Medical office professionals, healthcare technology providers, and medical billing companies alike were eagerly awaiting the Centers for Medicare & Medicaid Services’ (CMS’) latest announcement on October 6th, in which they released the finalized modifications to the Stage 2 rules of Meaningful Use and the updated Stage 3 regulations. (In addition, they announced a 60-day public comment period about Stage 3 of the EHR Incentive Program as it relates to the Medicare Access and CHIP Reauthorization Act of 2015.)

Why the anticipation? Stakeholders were eager to find out if the CMS would address their concerns – which were plentiful. In recent months and years, doctors, technologists, and industry observers have been vocal about the flaws they see in the various stages of the Meaningful Use program, especially what they view as overly burdensome attestation and reporting requirements.

The good news: Some relief is in sight. Healthcare industry experts are still parsing through all of the nuances of the announcement (and the 752-page rulebook that accompanied it) but it’s clear that with the latest changes the CMS is aiming, in its own words, to “simplify requirements and add new flexibilities for providers to make electronic health information available when and where it matters most.” The most important takeaways from the Meaningful Use updates are highlighted below.

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How to Keep High-Deductible Health Plans from Hurting Your Revenue

11/17/2015

Since the passage and implementation of the Affordable Care Act, the rise of high-deductible health plans has shown no sign of stopping. As patients increasingly purchase low-cost, high-deductible coverage from their national or state healthcare exchanges, practices have had to face the issue head on – deciding up front which plans to accept, which to turn away, and how to handle the overall impact on patient relations.

The bright side: 17 million more Americans are insured now than were pre-ACA, meaning your potential patient base is larger than ever. But due to the higher costs they face, high-deductible patients are far less likely than employer-covered ones to actually pursue care, follow through on treatment plans, and return for follow-up visits.

As such, it’s vital for your practice to take a proactive approach to patient awareness and education in order to seize your share of the newly-covered-patient market without hurting your income. Here are some of our recommendations as a medical billing company to help you embrace the high-deductible reality.

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Best Practices for Better A/R Management

11/03/2015

With ICD-10 finally upon us, it’s time to face the consequences. Some predict the impact will hit claim's denial rates the hardest, with jumps as high as 50-100% estimated in the early days of the transition.

As such, there’s no better time to get your Accounts Receivable in order. Capture more of what you earn by making sure to follow these two best practices.

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3 Surprising Ways to Put Data to Work for Your Medical Practice

10/27/2015

To keep the wheels turning at your practice, you periodically review reports on many different aspects of your operations: patient encounters and no-shows; per-provider performance metrics; revenue cycle effectiveness. If you’re like most doctors and medical practice management, you review your data with a dual mindset: a reflective approach (“How did we do last quarter?”) and eye for improvement (“Let’s do 10% better this time.”)

Of course, that’s what you should do... but it’s not ALL you should do.

Whether you’re running a group practice or a single-practitioner practice, your front- and back-office operations produce a wealth of useful data that you’re likely not utilizing to full advantage. Try these three techniques, then get creative to see what other applications you can come up with.

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Should You be Concerned About Insurance Switching Patients?

10/20/2015

If there was one issue that shaped the narrative of health insurance reform under the Affordable Care Act the most, it was that of individual patient coverage: who would get to keep theirs, who would lose theirs, and who would switch.

As we inch closer to another election cycle – one in which healthcare reform is again a high-level campaign issue – that concern is coming back into focus. But with the first few years of ‘Obamacare’ behind us, we finally have some numbers to help us assess the ACA’s impact on patient behavior when it comes to insurance.

As you’ll no doubt remember, the biggest ‘coverage controversy’ surrounding President Obama’s modification of the American health insurance system was his much-touted campaign promise: “If you like your healthcare plan, you can keep your healthcare plan.” When 4 million people received cancellation letters following the implementation of the ACA, it became clear the President’s soundbite wasn’t as true in practice as the public had hoped.

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Lean Medical Practice Management: Is It Right For You?

10/13/2015

Disruptive technological innovation is impacting industries as disparate as manufacturing, finance, travel, transportation, and of course, healthcare. From EHRs, document management to practice management systems, dozens of new products and tools – many built by upstart young technology companies – are changing the face of medical office administration as we know it.

In part due to government incentive programs, practices across the country are increasingly embracing emerging technologies. Yet as our industry begins to adapt to a changing market, it’s important that we learn as we evolve – and the companies that are driving the healthcare industry’s disruption are a fertile breeding ground for lessons on achieving success.

First published in 2011, Eric’ Ries book The Lean Startup has become the seminal guide for tech entrepreneurs around the world. Ries’ lean startup management ethos aims to turn the growth and scaling of a technology company from an art into a science by providing a framework for entrepreneurs to test their hypotheses, meet their customer's’ needs, and stay flexible enough to redirect (or “pivot”) their businesses when necessary.

Naturally, not all of the methodology of lean startup management can be incorporated into medical practice management. But the key principles of the lean startup ethos apply pertinently to businesses across all industries, (as a medical billing company we apply this ethos everyday) … and a vital key to improving your medical billing outcomes is to view your medical practice as a business, not just a vehicle for delivering patient care. Here’s how to utilize several of Mr. Ries’ top “lean” principles for your own practice’s success.

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Breaking News for Meaningful Use in 2015

10/07/2015

On October 6, 2015, the Centers for Medicare & Medicaid Services (CMS) released their revised final rules to both Stage 2 and Stage 3 measures. Most importantly Stage 2 Meaningful Use attestation for 2015 is now a 90 day period rather than the initial 365 day requirement.

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Could Virtual Visits Boost Your Revenue?

10/06/2015

Physicians and medical practice managers face a lofty challenge every day when it comes to balancing what’s best for their patients with what’s best for their bottom line. There are times when it feels like mutually beneficial solutions are hard to come by, but there may be one going unconsidered: telemedicine.

Think about the most difficult kind of day at your practice. What does it look like? For most medical practices, the “perfect storm” comes when your staff is overwhelmed, consumed with the needs of patients in the office and swamped with calls and emails, and your physicians are frustrated with the schedule, annoyed at spending so much time on follow-up visits and so little on critical patient concerns and high-level encounters. Telehealth solutions – aka telemedicine or “virtual visits” – can alleviate some of that practice-wide stress.

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Three Surprise Benefits of a Medical Billing Service

09/29/2015

When considering the switch to outsourced medical billing services, doctors and medical practice managers typically focus on the most obvious benefits: lower overhead costs, decreased demand on staff, improved and more consistent cash flow.

Yet those cut-and-dry advantages aren’t the only ‘pros’ of contracting with a medical billing firm. The effectiveness of your revenue cycle management (RCM) efforts is the most important indicator of your medical practice’s overall success, so when the responsibility for billing outcomes is transferred to an outside entity, the benefits reaped can go far beyond finances. Here are three bonus ‘perks’ you may not expect.

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ICD-10 Update: How CMS is Easing the Big Transition

09/22/2015

On July 6, the stuff of comic book legend happened: Two antagonists joined forces for the benefit of their shared community. But we’re not talking about Batman, Catwoman, and Gotham here – this time, it was the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA).

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MIPS 101: Understanding the New Merit-Based Incentive Payment System

09/15/2015

Just when you got comfortable with every other incentive program - from Meaningful Use of EHRs to the Physician Quality Reporting System (PQRS) to Value Based Modifier payment structures (VBM) - here comes another: MIPS, or Medicare’s new ‘Merit-Based Incentive Payment System.’ The introduction of MIPS may be a blessing for medical practices, since, it merges the other three programs into one.

MIPS emerged thanks to the long-awaited sustainable growth rate (SGR) fix legislation that passed the House of Representatives in March. The program isn’t final, as a variety of changes are expected to be made to the legislation as it makes its way through Congress, but in its current form it’s fairly easy to understand. Here’s what we know so far:

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Overwhelmed With A/R? Here's How to Get Streamlined

09/08/2015

If you don’t revisit your processes and procedures for Accounts Receivable regularly, they can easily get out of hand. Your practice is collecting from thousands of patients and potentially dozens of payers - and without regular maintenance, your A/R won’t stay a well-oiled machine for long.

Working with a medical billing service is one way to keep your A/R running smoothly, since an outsourced firm will have the resources and knowledge necessary to help you keep your payers paying and your patients out of collections. If you’re not ready to take that step, however, there are several things you can do to make your A/R efforts a lot less messy - and we suggest you start now!

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4 Simple Ways to Grow Your Patient Base

09/01/2015

Thanks to the passage of the Affordable Care Act, there are nearly 17 million more insured individuals in America’s health insurance system than there were in September 2013. There’s arguably never been a better time in history for medical practices to boost their revenue by bringing in new patients. How is your practice capitalizing on the opportunity?

If you’re seeing slowed income growth (or a lot of empty slots in your day-to-day appointment schedules) then it’s not only smart for you to grow your patient base, it’s imperative. Here are four top tips on broadening your exposure to new audiences and expanding your patient network in the process.

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Concierge Care: Is it Right for Your Practice?

08/25/2015

Depending on who you ask, concierge medicine is one of two antithetical things: an elitist, small-minded approach to practice management and patient care; or a more egalitarian, logical solution to the problems of today’s healthcare system.

Concierge care or “retainer-based” medicine is a model in which patients pay an upfront fee to secure physician services. With estimates putting the number of concierge docs at around 5,000, the approach is far from widespread – but it is growing. The most recent survey from the Physicians Foundation found that almost seven percent of providers planned to convert their practices to concierge in the next one to three years.

The growing numbers have many healthcare observers worried, believing that the concierge model is an exclusively “boutique” approach. Negative articles on the trend typically portray the concept as “pay up or lose care,” focusing on those doctors who shift to the concierge model to cap their patient base at an appealing number and earn more money from patients with deeper pockets.

But that’s not the only way it can be utilized. Some doctors, frustrated with the inherent limitations of the the payer-provider payment model, are leveraging the concierge approach to actually broaden their patient base:

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How to Simplify Physician Credentialing

08/18/2015

If credentialing a new physician is on your practice’s to-do list, it’s probably the line item you’re dreading the most. There’s not a medical professional among us who wouldn’t describe the physician credentialing process as tedious, time-consuming, and burdensome – the kind of onerous medical practice task that feels like it sucks up way more office energy than it should.

For the uninitiated: Credentialing is the process used by payers to evaluate the qualifications and practice history of a doctor or other practitioner. Credentialing requires physicians to verify their  education, training, residency, licenses, malpractice coverage, clinical judgment, and any certifications related to their specialties. The process that involves data collection, source verification, and committee review… and yeah, it’s as bad as it sounds.

But it’s also extremely important for both parties involved (payer and provider). Not only does it ensure patient safety, it paves the way for practices to enjoy proper reimbursements and on-time payments from their contracted third-party payers. Ultimately, credentialing is a necessary evil on the road to medical practice income – so it’s crucial for you to

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Could Non-Compete Agreements Help Your Practice Compete?

08/11/2015

Brace yourselves: The physician shortage is coming for your practice. According to a recent report from the Association of American Medical Colleges (AAMC), the U.S. will face a shortage of as many as 90,000 physicians by 2025 as the ‘boomer’ generation ages.

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How to Launch a Profitable Private Practice

08/04/2015

Across the country, physicians are increasingly seeing the value of independence. Whether escaping hospital employment or breaking out of group practice to go solo, more and more doctors are heading into private practice.

If you’re fantasizing about opening up your own office, you know there’s a lot more to think about than leases, equipment, and software. It’s crucial to lay the groundwork for success from the get-go – otherwise you risk playing catch-up after your doors are already open. Tackle the following must-dos before scheduling your first patient visit.

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Denying Denials: 3 Simple Ways to Bolster Denial Management

07/28/2015

The only way to keep your practice afloat is to make sure your revenue stream stays steady. If you’re not paying close attention to your denial rate – and making headway toward improving it – you’re putting your practice at risk.

A denial rate below 5 percent should be the goal of every medical practice. If that seems wildly unattainable given your current performance, that’s not a good sign; consider contracting with a medical billing service to get your reimbursements back on track.

If you’re hovering in the 6-10 percent denial range, however, a few changes and improvements to your medical billing processes may be all you need to start getting paid more of the money you deserve from the payers in your network. Try the following denial management tactics, then measure the results they reap at your practice.

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Optimize Scheduling to Improve Practice Returns

07/21/2015

If things at your practice feel like they’re falling off the rails – you’re overly busy and understaffed, your denial rate is soaring, your revenue is stagnating – the unlikely culprit may be sitting on the counter at the front desk. Your appointment book (or online appointment calendar) could be the source of all of your problems.

Scheduling is an aspect of practice management in which even the savviest medical office professionals get sloppy. It’s easy to fall into seemingly innocuous routines and patterns that, upon review, harm more than they hurt. If you’re not auditing and reviewing your scheduling processes regularly, there’s undoubtedly room for improvement at your practice.

Sit down with your top two or three appointment bookers and look back at your weekly schedules for the past six months with a critical eye. See how you can optimize operations by streamlining your schedule in each of the following areas.

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What Productivity Metrics Should You Measure?

07/14/2015

How committed is your team to making your practice the best it can be? From your medical billing department to your clinical staff to your front desk reps, everyone involved in day-to-day business around your office should be motivated to help you become a top-of-the-line medical establishment.

But instilling a competitive instinct in your staff requires a top-down approach. If your practice management team isn’t setting goals and monitoring, measuring, and improving your overall results, you can’t expect your staffers to understand what objectives they should work toward.

One vital area of practice performance is productivity metrics. Making productivity gains requires that you pinpoint certain metrics to measure, set benchmarks, and take actions based on data - rather than just hum along at a baseline level of efficiency and output. Consider the following performance areas as you outline a productivity assessment plan.

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Reduce Practice Risk through the Dos and Don’ts of Documentation

07/07/2015

Even in today’s increasingly complex healthcare environment - where technology and new laws impact almost every aspect of medical billing and practice management - one of the most valuable tools to protect your practice is the most simple: your pen.

Each medical record in your office is a living legal document. Ensuring that all of the documentation inside them is thorough, accurate, and legible should be a primary concern for every medical practice, but it’s not typically prioritized. How often do you review the completeness and quality of your medical documentation?

Whether you use electronic health records, paper charts, or both, it’s crucial to revisit your documentation processes and procedures regularly to ensure that you’re keeping your malpractice risk to a minimum. Here are the keys to keep in mind.

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Revisiting Eligibility Checks: Are You Doing Them Wrong?

06/30/2015

We can’t stress it enough: checking a patient’s insurance in advance of each and every encounter is the number one way to avoid medical billing issues. So why do so many practices neglect them?

To be fair, few medical offices skip eligibility checks altogether: Almost every practice conducts an insurance check before seeing a new patient, and plenty of offices utilize technology systems that automatically verify insurance as part of the revenue cycle management process.

Yet the majority of medical practices occupy a ‘gray area’ when it comes to eligibility checks –

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Is Your Practice at Risk for a Payer Audit?

06/18/2015

Even if everyone at your practice loves surprises, there’s one surprise that’s unwelcome: a payer audit. Being audited by Medicare or another government payer is a top fear of many medical practices… one that almost always feels like a threat.

Payer audits are intimidating because so few practitioners and medical practice managers understand their origins. Armed with just a baseline understanding of the trigger factors (too much high-level coding; overuse or misuse of modifiers), some practices over-correct to avoid issues. But by deliberately undercoding encounters to avoid attracting unwanted payer attention, those medical practices are selling themselves short.

One way to lessen the odds of an audit is to contract with a medical billing company. A medical billing firm with the resources, detailed practice management knowledge, and capacity to manage all of your claims can help you spot audit-inducing issues before they happen. If that’s not an option for you, it’s important for your team to assess whether it’s at risk and to course-correct as necessary. Here’s a rundown of what you need to know.

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What High-Deductible Health Plans do to Your Bottom Line

06/11/2015

Opinions about the Affordable Care Act – and all of its repercussions – continue to vary widely among stakeholders in both the health care industry and the public at large. One of its most prominent (and provocative) consequences has been the rise of the high-deductible health plan.

These plans place more up-front financial responsibility on patients than traditional plans. That shift has a direct impact on medical practices, which is why so many providers limit the number of exchange-purchased plans they participate in.

Yet it is possible for practices to operate successfully amidst the new landscape, and it’s wise for them to try. The trend of increased patient responsibility isn’t going away any time soon; one in five Americans is already covered by a high deductible plan. To effectively adapt their practice management techniques, doctors should know what to expect with the new plans and how to proactively mitigate the effects.

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Navigating New Medicare Modifiers: Meet XE, XP, XS & XU

06/04/2015

It’s not just ICD-10 that’s requiring medical billing and coding to get a lot more specific! In August, Medicare made it clear to providers that they recognized the inadequacies of the 59 modifier (“distinct procedural service”) and introduced four new modifiers to ideally be used in its place: XE, XP, XS & XU. If your billers and coders are saying “X what?!” then it’s critical they get more familiar with the new medicare modifiers.

For background, the 59 modifier has long been one of the most misused modifiers in the revenue cycle management industry. Its intended use is to signify that that two or more procedures were performed on the same date of service for ‘distinct’ medical reasons, but it’s often used more manipulatively by practice management organizations to “unbundle” two related procedures to receive higher reimbursement.

The 59 modifier is not being eliminated, but with the introduction of the four replacement modifiers it’s obvious, Medicare is trying to lessen the misuse of the more general “distinct procedural service” and lower associated denials and claim resubmissions. The key is to drill down to why the procedural service is distinct, and to use the appropriate modifier. Here’s how the four new modifiers shake out and examples of how each should be used.

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Considering Participating in an ACO?

05/28/2015

As a medical billing company we are seeing the health care industry evolve, value-based care is becoming increasingly important to the governmental powers that be. But it matters to practices, too! If delivering enhanced, collaborative care to your patients is a growing priority for your practice, you may be captivated by the opportunity to participate in one of the most successful initiatives in the value-based care movement: the ACO, or Accountable Care Organization.

 

What’s an ACO?...

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How to Hire Great Staffers for Your Medical Practice

05/19/2015

How to Hire Great Staffers for Your Medical Practice

As you look around your practice, you likely see many areas where you could invest in new resources: technology, infrastructure, new devices. But what about your human resources?

Your investment in your staff is arguably the one with that reaps the highest dividends on your office’s productivity, patient satisfaction, and revenues. That’s why, whenever a team member quits or retires, it’s critical for you to take a long-term approach to hiring a new employee who will be a good fit for your team and make a strong contribution to your success – not to just get a new body in that empty seat as soon as possible.

The best bet is to look for an employee with the right mix of several qualities experience, teachability, enthusiasm, and commitment – that you can assess throughout the different phases of the hiring process.

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Why are Docs Opting Out of Meaningful Use?

05/07/2015

Why are Docs Opting Out of Meaningful Use?

The Meaningful Use program – designed by the Centers for Medicare and Medicaid Services (CMS) to speed up adoption of electronic health records (EHRs) – is not everyone’s favorite initiative. But just how unpopular the program is across the healthcare industry may surprise you.

According to a 2014 report from Medscape, 22 percent of physicians are opting out of Meaningful Use. (16% of those surveyed said they will never attest to the CMS’ requirements, and another 6% of participants said they abandoned the program after meeting the requirements in previous years.) A survey from SERMO predicts that over 50 percent of physicians will not attest to the requirements in 2015.

So what’s motivating docs to drop out? 

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How to Craft a Better Medical Collection Letter

04/29/2015

One of the most frustrating aspects of medical billing and practice management is patient collections. It’s a touchy situation – one in which you need to be firm in your approach but sensitive to the many concerns at play (patient financial hardship and medical-issue severity among them).

If you want to stay in good standing with your patients or avoid negative on-line reviews, it’s critical to avoid offending your patients as you move through the collection process. But that shouldn’t keep you from doing everything in your power to collect unpaid balances.

Many practices go years (if not decades) without reviewing the language and other content included in their collection letters. Don’t be one of them! Take a look at yours and keep the following best practices in mind.

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Is Your Practice Ready for the Google Search Update?

04/20/2015

The Mobile Friendly Google Update

Tomorrow, Tuesday, April 21, Google is making a major update to its mobile search algorithm that will change the order in which websites are ranked when users search for something from their phone or tablet. As your business partner we wanted to make you aware of this change so you can stay ahead of your competition.

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SGR and Doc Fix Update

04/15/2015

SGR Update

Last evening, by a vote of 92 – 8 the Senate passed H.R. 2, legislation that would permanently repeal and replace the Medicare Sustainable Growth Rate formula (SGR). There were six amendments offered during floor consideration and all were defeated. Therefore, the Senate has passed the bill in the identical form as the House passed version. This means that the bill can immediately go to the President for his signature. The President has previously agreed to sign this bill into law.

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Could Group Visits Boost Your Revenue?

03/31/2015

Could Group Visits Boost Your Revenue?

Shared medical appointments or “group visits” have long been an option for medical practices, but in recent years they’ve been on the rise. The American Academy of Family Physicians estimated that the number of physicians performing group visits rose from 5.7 percent in 2005 to 12.7 percent in 2010.

How does a group visit work? Instead of scheduling individual patients – all dealing with the same medical issue – for one-on-one 15 minute encounters with the MD, a practice books multiple patients to meet with the doctor for a longer period of time. (Depending on the size of the group, the session may be as long as two hours).

Certainly, group appointments work for some specialties better than others. If you serve a large base of chronic-care patients or otherwise have a significant number of patients facing the same medical condition, group visits could be a secret weapon for your productivity and revenue stream.

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Start Preparing Today to Prevent ICD-10 Denials

03/10/2015

October 1, 2015 – and with it, the mandated shift to the ICD-10 code set – is right around the corner. Though the implementation date has changed before (three times since 2009), there seems to be no postponement on the horizon this time around.

The CMS recently successfully completed its first week of end-to-end testing of ICD-10 coding and announced its opinion that the “industry is ready to take the next step to modernize healthcare.” But they may not be right about that. A new survey found that only 21 percent of physician practices feel they are on track with preparation efforts. That’s not a good sign!

Are you prepared for the switch? According to the Healthcare Information and Management Systems Society, providers will likely face delays in processing authorizations, increased claims rejections and denials, improper reimbursement, and slowed or reduced cash flow as a result of ICD-10. Some of those effects may be unavoidable, but there are a few steps you can take now to minimize the impact of ICD-10 on your practice’s operations.

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The 5 Questions You Must Ask a Medical Billing Service

03/03/2015

The 5 Questions You Must Ask a Medical Billing Service

If your practice is struggling with its revenue cycle, it may be a smart decision to outsource back office operations to a medical billing company. But the billing service you select will become more than just a technology vendor – they’ll become a partner in your financial success.

It’s crucial for you to choose a medical billing service very, very carefully. Cost will naturally play a role in your decision, but it shouldn’t be the only concern you focus on as you consider your options. As part of the selection process, be sure to ask the following questions.

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Can Patient Education Improve Your Revenue ?

02/24/2015

Does Patient Education Improve Your Revenue?

Medical practices are under pressure from so many formidable factors – dwindling reimbursements, crammed schedules, changing healthcare laws and regulatory requirements – that sometimes even the simplest efforts to improve financial performance end up on the low end of your priority list (if they make the list at all).

One example is patient education. It’s a no-brainer that a fully informed patient will likely be a happier one and be more likely to show up on time, pay in full, and follow their doctor’s orders. But due to a lack of time, resources, or knowledge, medical practices often give patient education little attention across the board.

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Do You Know If You Are Up-coding?

02/17/2015

Your practice would (hopefully) never deliberately overcharge patients, but you may be guilty of doing it nonetheless. Upcoding – the practice of coding and thereby billing at a higher level of service than is appropriate for services or procedures rendered – is a much more pervasive problem than most medical practices realize.

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5 Tips for More Productive Medical Billing

02/03/2015

5 Tips for More Productive Billing

Timely, accurate, and full reimbursement is the most important metric for keeping the lights on at your practice. But only around 70 percent of claims submitted are processed and paid on the first submission – leaving a whopping 30 percent unprocessed, returned unpaid, or requiring additional energy and time from your staff for resubmission.

Are you doing enough to make sure you’re always paid what you deserve? Follow these quick tips to get paid in full more efficiently.

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Stop Risking Your Revenue

01/13/2015

Are You Failing to Spot the Top Risks to Your Revenue?

With payer reimbursements continuing to decline, providers and medical practice managers know that they can’t afford to let revenue slip through the cracks. Yet many are losing money without even realizing it, simply because they aren’t noticing areas where they’re underperforming, making mistakes, or operating inefficiently.

Starting the new year off on the right foot means mitigating risks appropriately… and “risk management” is just as critical to your revenue cycle as it is to patient interactions. Review your performance in each of these risk factor-laden areas of your revenue cycle.

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Medical Billing Tips: Put an End to Underpayments

01/09/2015

How to Put an End to Underpayments

Practices tend to consider their contracts with payers to be binding commitments… but are they? Data from the American Medical Association shows that most insurance companies pay practices just 86-92% of their contracted rates. 

If you’re not paying close attention to payer payments, your practice could be getting gouged. Eliminating underpayments is critical, but requires education, data, and a proactive approach.

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Medical Billing Tips: How to Resolve Patient Billing Problems

12/23/2014

How to Resolve Patients Billing Problems

Your practice does a lot for your patients’ physical health, but are you doing anything for their financial health? Medical billing can cause a lot of headaches for patients, especially if they feel that their provider isn’t doing enough to help them understand their bills and resolve problems that come up.

Not every practice is equipped to help patients resolve billing problems, due in part to budget shortages, staffing issues, or other factors.But if you’re looking to enhance your patients’ all-around experience with your practice in the new year, improving medical billing is the perfect place to start.

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Negotiating Payer Fee Schedules? Here's 5 Tips that will Help!

12/16/2014

As your practice’s year comes to a close, now is the time to review your financial performance and consider the factors that impacted your revenue – including your payer contracts.

If your relationships with your payers are longstanding, it’s likely been a while since you’ve revisited (and renegotiated) your payer fee schedules. But if you aren’t regularly making sure your payment rates are up to par, you may be underpaid.

The key is to work with your medical billing service or staff to collect and analyze payer payment data, then use it as a bargaining tool with the insurance companies. Here are our top tips to help you make sure you get paid every dollar you deserve.

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Practice Management Tips - Streamline Collections

12/04/2014

How to Streamline Collections to Boost Your Revenue

No matter how many patients you serve and how low your denied claims rate, any and all unpaid balances weigh down your revenue stream and overall practice management. Since collecting past due balances can be complicated, many practices keep unpaid copays and other bills on their books for far longer than they should.

A few simple steps can go a long way toward streamlining patient collections and keeping your revenue stream consistent. Incorporate these efforts into your practice.

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How and Why to Perform a Medical Billing Audit

11/25/2014

If you’re happy with your practice’s reimbursements and you haven’t seen a recent spike in denials, you may feel like your medical billing operations are coasting along just fine. But is fine good enough?

It’s critical for practices large and small to earn every dollar they can. If you don’t periodically audit your systems, efforts, and results on the medical billing front, you’re almost certainly not operating at your optimum performance level.

How in-depth you decide to go with an audit is up to you… but more is better (especially if it’s been a while since you revisited your billing policies and procedures). Since every medical practice is different, there’s no one-size-fits-all checklist for auditing billing and coding, but there are some general steps every office should take and key considerations along the way.

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Healthcare Analytics and Medical Billing Services

11/19/2014

Medical billing services typically know how to dodge the manual errors, timing issues, and outright mistakes that frequently cause claim denials. (Denials due to ineligibility, missed filing deadlines, and plain old miscoding are common across all specialties.)

Avoiding these common claim errors will help reduce overall claim denials, but to really lower your rejection rate, your coders or medical billing company must have an in-depth understanding of the big picture.

Through healthcare analytics tools we can shed new light on denial patterns across many practices. These are the top five most commonly denied procedures and the payers’ associated reasons for denial. To help you keep these denials from slowing down your revenue cycle, we’re also sharing our common-sense wisdom on avoiding them.

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Practice Management Tips - Update Your Medical Billing Policies

11/04/2014

Is it Time to Update Your Medical Billing Policies?

Like many other areas of your practice, your medical billing is likely a matter of routine.  If your staff members know how to do their jobs well, your billing department may run like a well-oiled machine.  But is that machine operating at optimal efficiency?

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Considering A Medical Billing Service? 5 Questions You Need To Ask!

10/28/2014

As the end of the calendar year approaches, many practices perform self-audits to determine areas where their practice management systems and processes can improve.  Billing and compliance roles are often at the top of the list.  Is your practice overwhelmed with the multiple layers of non-clinical duties, such as reporting and compliance programs?  Are you considering outsourcing these tasks by partnering with a revenue cycle company?  If you answered “yes,” here are five important questions you need to ask any billing company to ensure a successful partnership and a return on your investment.

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Medical Billing Tips - Simplify Payer Enrollment

10/21/2014

Using CAQH to Simplify Payer Enrollment

Working with payers is not always easy. (Denied claims, long remittance times, and coverage disputes have likely caused more than a few headaches at your practice.) But thanks to an initiative from the Council for Affordable Quality Healthcare (CAQH), provider enrollment with payers is a little simpler than it used to be – giving you less reason to reach for the ibuprofen.

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Medical Billing Services - Key Performance Indicators

10/15/2014

In today’s ever changing healthcare environment, many small medical practices are struggling to stay afloat.  Do you have one of those practices?  Are you feeling overwhelmed?  Most physicians feel that they are working harder than they have ever worked before but getting paid diminishing returns.  Fighting for every dollar seems to be the trend.

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A Survival Guide to PQRS Reporting

10/07/2014

Over the last few years Meaningful Use and ICD 10 have received most of the attention from the press and professional societies, but in our experience it is PQRS requirements that most practices are failing in their preparation and reporting. 

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Top 5 Medical Billing Mistakes (and How to Avoid Them)

09/30/2014

Top 5 Medical Billing Mistakes (and How to Avoid Them)

Running a cost-effective, efficient medical practice requires a steady and reliable revenue stream… and that’s something you can’t achieve if your billing efforts aren’t optimized for success.

Whether they incur delayed payments, denials, client complaints, or even just lost productivity, medical billing blunders hurt your practice. Eliminating errors is critical to your bottom line, so follow our tips to make your billing efforts more effective.

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Medical Billing Tip: Keep Your Practice on Track for ICD 10

09/23/2014

ICD 10: Keeping Your Practice on Track

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Medical Billing Tip: Consider Time-based Coding for E/M

09/11/2014

Sometimes a visit goes long – an extra five or ten minutes – and it throws off your morning schedule. Other times, a visit goes way too long – an extra 20, 40, or even 60 minutes – and it practically wrecks your entire day’s schedule.

As a medical billing company we hear from providers that are hesitant to charge for that extra time, especially if it was spent providing consultative services or addressing a patient’s personal or emotional issues. In certain circumstances, however, it is appropriate to bill for extra time using either a higher level evaluation and management (E/M) code or prolonged service codes.

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Meaningful Use Stage 2 Webinar

09/03/2014

According to the U.S. Center for Medicare and Medicaid Services (CMS), 408,000 eligible providers have received EHR incentives totaling close to $6.5 billion, but it seems that the program is losing some of its initial momentum. Stage 2 Attestations 

Meaningful Use is a core requirement of the Health Information Technology for Economic and Clinical Health (HITECH) program. The program is part of the government’s larger efforts to move towards value-based healthcare through increased access to clinical information for all stakeholders, thereby improving quality, patient outcomes and cost containment. In order for providers to demonstrate Meaningful Use understanding the criteria and process is critical, as is selecting the right technology partner.

As an extension of our commitment to education,  NCG Medical and our medical billing services team we are excited to provide this review of Meaningful Use Stage 2 requirements.

Need Help With Meaningful Use? Contact Us.

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Medical Billing Tips - Provider Credentialing

08/27/2014

All medical billing is predicated on physicians being credentialed, but the process has become increasingly difficult due to payer and state-specific requirements. Here are three tips to make your provider credentialing easier:

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Introduction to PQRS Webinar

08/20/2014

Did you know this is the last year CMS will offer a 0.5% incentive payment for successfully participating in the PQRS program? Are you aware that penalties will increase from 1.5% to 2% for not participating? 

If not, watch this informational webinar and see just how easy it is to succeed in PQRS!  

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Reporting PQRS via Registry – Do you know how?

08/18/2014

If you answered “Yes” to this question, congratulations you should be receiving your 2013 payment anyday now! Use this blog as a reference to ensure you reported your PQRS measures via registry correctly.  If you answered “No,” then this information is just what you need to know for the 2014 reporting period.

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Revenue Cycle Management Tips - Top Tools For Medical Practice Managers!

08/13/2014

Running a medical practice in today’s day and age is becoming quite the challenge for many.  Multiple layers of government compliance programs, decreased payments from insurance programs, staff management needs and most important, customer service and patient care. 

Listed below are 10 excellent revenue cycle management tools every medical practice manager should be aware of and utilizing in their practice.  

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Physician Billing Best Practice: Prepare for Meaningful Use Audits

07/17/2014

NCG Medical is more than an Orlando medical billing company, we also develop practice management software, document management software and electronic medical records (EMR) to aid all aspects of revenue cycle management. Lately we have been hearing more and more from EMR users about government Meaningful Use (MU) audits. As a physician billing best practice, we recommend you complete an internal review of your reporting measures to ensure you can defend any challenges in a formal audit.  We also recommend keeping all of your supporting documentation together for each attestation year.  

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3-Steps To Choosing a Medical Billing Company

07/03/2014

Deciding which medical billing company to work with and what corresponding billing services to outsource is more than just comparing rates. When considering outsourcing you hand over a critical component of your management. It is vital you choose a vendor that you view as a partner, and is invested in the success of your practice.

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Physician Billing Best Practices

06/30/2014

You've probably heard many times before that if you want to have predictable cash flow you have to have great revenue cycle management.

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Medical Billing Service Tips: Split Names into Columns in Excel

06/26/2014

As part of NCG's Medical Billing Services, I regularly find myself working with large patient lists in Excel.  In those lists, it is very common for the patient’s first, middle, and last names to be combined into one single column.

This makes it impossible to sort or filter the data based on the patient’s last name, until you split the single name column into multiple columns for first, middle, and last names, as seen in the example patient list below.  It's actually very easy to do this in Excel, and in this article I will show you how.

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Participating in the Physician Quality Reporting System

06/26/2014

By Daniel H. Green, MD, FACOG

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How Will the Proposed New Timeline for the EHR Incentive Program Affect Your Practice?

12/20/2013

What you need to know about proposed extension of Stage 2 and updates on Stage 3 timeline

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In a year of seismic change, NCG Medical will make your practice thrive

12/09/2013

Guaranteed Success in 2014

In a year of seismic change, NCG Medical will make your practice thrive

Medical practices will encounter unprecedented changes in 2014. The ICD-10 transition and Stage 2 of Meaningful Use are hitting the calendar the same year. Both will cause administrative and financial trials for practices.

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Consider Section 179 Deduction Before it Sunsets

11/26/2013

Bottom-line Saving Tip:

If you’re looking to make capital improvements, including the purchases of hardware and software to help your office, you might want to take advantage of a valuable tax deduction before the end of the year.

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Keep Your Business's Revenue Cycle Moving with a Smooth Transition to ICD-10

11/11/2013

Your business’s revenue cycle moves like a fine oiled car, and you’ve worked hard to tune each part. With the transition to ICD-10 approaching, avoid stalling out - seek help! Without proper planning, your revenue cycle is headed straight for a crash after the October 1, 2014 ICD-10

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Sign up for a free practice assessment today

10/15/2013

Are you getting paid what you want?
If you are working harder and taking home less money than you did a year ago - it is time for a checkup on your business financials.

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Are you managing your AR effectively?

09/25/2013

Let NCG Medical clean-up overdue receivables

Running a medical practice is tough enough without having to worry about receivables creeping past 60, 90 or even 120 days.

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It’s time for your annual checkup and NCG is accepting walk-ins!

06/26/2013

With the calendar pages flipping from June to July – we have reached the halfway point of 2013. Now is the perfect time for a financial checkup of your practice so you can fine tune the health of your operations. NCG provides complementary billing

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Alert: Inspector General Demands Physicians Improve Records for NPI Files and PECOS or Face Losing Medicare Revenue

06/19/2013

HHS investigation says poor records can signal Medicare fraud

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Alert: Government stepping up audits for Meaningful Use Compliance

06/12/2013

Meaningful Use audits are happening and NCG wants you to be prepared and prevent your practice for being at risk of losing EHR meaningful use incentive money.

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Does Medicare know you’re writing electronic prescriptions?

06/10/2013

Bottom line saving tip: Submitting the G-code is the pathway to avoiding a 2 percent Medicare penalty

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Have You Heard of Appointment Reconciliation?

05/01/2013

When waving good-bye to a patient, what do you see walking out the door? Is it money?

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Save time and money, verify patients first

04/16/2013

Your time and your staff’s time are valuable. But your practice is wasting everyone’s time if you’re treating patients prior to checking on their insurance eligibility and coverage.

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Ignoring PQRS could cost you $$$

03/27/2013

Most practices are unprepared: But there is still time to act

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Monitoring your AR: How is your practice’s health at 90?

03/22/2013

Living beyond 90 is great when it comes to patient age, but on the balance sheet, bills older than 90 days can mean financial stress for your practice.

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Will EHRs soon be in the clouds?

03/13/2013

Last week the Office of National Coordinator for Health IT, part of the Department of Health and Human Services requested ideas to accelerate electronic health record exchange between providers, due to challenges with health information exchanges (HIEs).

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Florida Governor announces his push for Medicaid expansion

02/27/2013

Florida Gov. Rick Scott recently introduced a potential major shift for healthcare in the sunshine state when he announced that he will urge the Legislature to accept federal funds to expand Medicaid.

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New Children’s Electronic Health Record Software Announced

02/12/2013

The Agency for Healthcare Research and Quality (AHRQ), with backing from the Centers for Medicare and Medicaid Services (CMS) have announced the development of a new software that can help better Electronic Health Records (EHRs) for the care of children.

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Patient deductibles are rising; what does this mean for your office?

01/29/2013

With patient self-pay of deductibles already difficult for doctors to collect, and health plan deductibles continuing to rise the amount you collect from a patient is important.

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NCG Medical Reaches Milestone for Medical Billing Services

01/22/2013

More than 100 medical practitioners seek NCG’s expertise to
maximize their bottom line

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EHRs prove to be a gold mine for medical research

01/16/2013

Electronic health record adoption continues to rise in physicians efforts to convert from hand written doctors notes to electronic records. The goal remains the same – improve efficiency and cut costs. Recently a disappointing report published last week by

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Is Central Florida the next “medical battleground?”

01/10/2013

With new economic realities and the ever-changing healthcare reform, the trend of consolidation in health care has begun transforming the practice of medicine. According to estimates from Accenture, a consulting firm, the percentage of independent doctors nationwide now rests at 39 percent, down from 57 percent in 2000.

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Doctors moving to electronic health records increase

01/03/2013

According to the U.S. Department of Health and Human Services, the percentage of doctors who have switched to electronic health records (EHRs) has increased to 72%, climbing steadily in recent years.

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Consolidation – A Trend Changing Healthcare As We Know It

12/27/2012

Recently, healthcare has been changing rapidly. The way of doing things has changed because of the new legislation and the ever changing medical innovation forming new trends in the industry.

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Benefits of electronic health records are seen after Super Storm Sandy

12/18/2012

When Hurricane Sandy slammed into the East Coast, many physicians learned the benefits of electronic health records (EHRs) in ensuring safety of patient records. In the storm’s wake, as patients bounced between hospitals and other care facilities

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Florida to pay Medicaid primary doctors at higher rate

12/11/2012

NCG Medical would like to give primary doctors in Florida a heads up; with healthcare reform Medicaid doctors will now get paid at higher Medicare rates.

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The NFL tackles EHRs

12/04/2012

The 32 teams that make up the National Football League (NFL) will now run on an electronic health record system to better care for game-related injuries and better diagnose the all-too-common concussions.

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Look for New Ways to Maximize Practice Revenue in 2013

11/27/2012

By Antonio Arias

You have spent years building your practice into a profitable business with a good client base.

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What does the President’s re-election mean for Electronic Health Records

11/20/2012

With President Barack Obama’s re-election most of the remaining uncertainty regarding the implementation of the Affordable Care Act has been lifted and will continue to move forward. Health IT adoption, on which health reform depends

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Electronic Health Records – What we can do now that we couldn't do before

11/13/2012

Before electronic health records (EHRs), all the research and results for medical findings all came from years of clinical studies. It involved treatments based on what worked for the statistically average patient. Now, the knowledge about

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Electronic Health Records Aid in Diabetes Control

10/30/2012

A recent study released in the Annals of Internal Medicine says Electronic Health Records (EHRs) improve both care and overall outcomes for patients with diabetes.

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Rome Was Not Built in a Day: EHR Incentives are Working

10/22/2012

Federal incentives for meaningful use of electronic health records (EHRs) have become a topic of political debate. Recently, several House Republicans called for immediate suspension of EHR incentives. Health IT groups fired back, defending incentives. 

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NCG clears the air to negative EHR accusations

10/16/2012

With physicians and hospitals implementing electronic health records, recently there has been a lot of negative press regarding the adjustments.  NCG Perfect Care is here to clear the air by addressing the issues head on. 

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National Health IT Week

09/12/2012

This week marks 2012’s National Health IT Week (Sept. 10-14).  Nationwide reform for a system-wide adoption of health information and technology is not possible without raising awareness.  National Health IT Week brings the community of health information technology together to educate and inform how Health IT is a vital piece of doctors today providing,

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Healthcare Technology Helps Returning Veterans

09/10/2012

With the Iraq War officially ended and Afghanistan scheduled to pull back by 2014, scores of service members are beginning to head home. In an article in the August edition of HealthcareITNews, Secretary of Veteran Affairs Eric K. Shineski

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Perfect Care EHR Supports New Stage 2 Rules for Electronic Health Records

08/29/2012

Federal officials announce final regulations for the second stage of Meaningful Use, NCG’s Perfect Care is in compliance every step of the way.

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EHRs prove to help evidence-based medicine

08/28/2012

Through EHRs physicians will be able to access a patient’s full medical history, such as allergies and family history, with the click of a button. They will also have schedules and reminders at their fingertips, for example, when a patient might be due for

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Practices nationwide looking for replacement EHRs that can quickly qualify for federal dollars

08/21/2012

While many practices are just beginning their path to meaningful use with electronic health records, more and more practices are looking for replacement EHRs.

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Survey reports doctors are warming to electronic health records

08/14/2012

A national survey carried out by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, reports the perceptions and practices of nearly 3,200 doctors using electronic health record systems.

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Electronic health records help make the shift from volume to value systems

08/07/2012

For years the healthcare industry has been talking about making a switch from systems that reward volume-based providers to value-based providers. The Supreme Court’s decision to overhaul

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Electronic health records help fight epidemics

07/31/2012

A recent article in The New York Times addresses an unexpected benefit of electronic health records – the ability to help catch and manage epidemics in real time.

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Electronic health records go for the gold in the summer Olympics

07/24/2012

For Team USA racing against a digital clock is nothing new. Now it’s time for digital health records to race ahead of its paper counterpart.

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Harvard Study reflects drop in malpractice claims with electronic health records

07/17/2012

The study reveals doctors who switched to electronic health records had fewer malpractice claims than doctors who use paper records.

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Obamacare ruling may accelerate e-health spending

07/10/2012

The U.S. Supreme Court’s decision to uphold the primary provision of the Affordable Care Act or “Obamacare” will accelerate the industry's massive investment in information technology.

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The cloud provides Health Care IT solutions above the ongoing technology scrum

06/25/2012

Don’t look now, but some current major players in the tech world may actually be doomed.

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New EHR numbers show progress - more than one third of doctors have now attested for MU

06/12/2012

Nearly 18 months into the incentive program for electronic health records and a growing minority of doctors are qualifying for meaningful use. The latest report shows 36 percent of

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CMS warns that EHR non-compliance penalties could be more severe

06/05/2012

The Center for Medicare & Medicaid Services is giving new motivation to doctors by stating that penalties for not using EHRs in future years could be more severe than many think.

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Practicing in underserved areas can mean more stimulus money for Electronic Health Records

05/31/2012

The Center for Medicare & Medicaid Services recently noted that qualified medical professionals who serve in rural areas can receive a 10 percent bonus in stimulus funding for meaningful

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Doctors stare down EHR deadline: Risk losing thousands

05/25/2012

Tick. Tick. TICK. The clock is ticking for doctors who want to receive maximum federal incentives for electronic health records. We have been saying it for months that the time for doctors to join the EHR movement without losing money is

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NCG Medical Agrees to Defer 80 Percent of Costs for its Industry-Leading Electronic Health Record Solution

04/12/2012

Doctors who buy Perfect Care EHR can pay for the program with

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Perfect Care EHR Tops National Average for Getting Doctors Electronic Health Record Stimulus Money

03/26/2012

Perfect Care EHR qualifies medical professionals for incentive payments in less than 100 days

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5010 Update to the HIPAA Electronic Transaction Standards

11/28/2011

As a valued NCG Medical client, we want to assure you that you are prepared for the upcoming 5010 transaction requirements.   The NCG Support Team will contact your office prior to the deadline to perform the necessary update for 5010 transactions.  Begin preparation for the update by reviewing the information below and updating your Perfect Care system accordingly.  Please feel free to contact us with any questions at 800-330-1906 or email at questions@ncgmedical.com.

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NCG Medical provides EHR solutions for physicians

04/05/2011

Doctors looking for a certified selection in ambulatory electronic health records technology can now turn to NCG Medical.

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NCG Medical named Qualified EHR Vendor for PaperFree Florida

04/04/2011

PaperFree Florida serves doctors in the Tampa region

ORLANDO, Fla. (March 23, 2011) – NCG Medical, a global leader in electronic medical health records, has been named a qualified vendor for Electronic Health Records (EHR) for PaperFree Florida.

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NCG Medical Now Offers Two Certified Electronic Health Records Solutions

03/17/2011

Perfect Care EHR and Perfect Care EHR Lite Both Earn National Certification

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NCG Medical Receives ONC-ATCB Certification by Drummond Group

01/21/2011

ORLANDO, Fla. (Jan. 18, 2010) - NCG Medical Perfect Care EHR Meaningful Use Edition has received Complete EHR Ambulatory certification -- deeming the Electronic Health Record (EHR) software capable of enabling providers to meet the stage 1

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Ponce School of Medicine Names NCG Medical as Preferred Vendor

01/19/2011

Ponce School of Medicine Names NCG Medical as Preferred Vendor for Electronic Health Records for Puerto Rico

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NCG Medical Selected by Indian River County School District’s Adult and Community Education School

09/07/2010

NCG Medical Selected by Indian River County School District's Adult and Community Education School – Medical Coder/Biller Program

Selection Driven by Ease of Use, Interoperability Features

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NCG Medical Software Picked by Lake-Sumter Community College to Run Health Information Management Program

07/27/2010

Orlando, FL – July, 27, 2010

NCG Medical, a leading provider of electronic health records software (EHR), announced today that Lake-Sumter Community College (LSCC) has licensed NCG Medical's electronic health records system Perfect Care EHR to support its Health Information Management programs. Lake-Sumter Community College is the third academic institution in the state of Florida to license Perfect Care EHR.

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NCG Medical, Perfect Care EHR achieves preliminary ARRA 2011 certification from CCHIT.

12/11/2009

Altamonte Springs, FL

ORLANDO, FL– December 11, 2009

NCG Medical announces that their Electronic Health Record, Perfect Care EHR® has been inspected by the Certification Commission for Health Information Technology (CCHIT®)

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NCG Medical announces its participation in Preliminary ARRA 2011 certification program.

10/07/2009

Altamonte Springs, FL

ORLANDO, FL– October 7, 2009

NCG Medical announces Perfect Care EHR’s® participation in The Certification Commission for Health Information Technology’s (CCHIT®) new certification program.

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NCG Medical scholarship: UCF Program Prepares Students for a New Era in Health Care

08/27/2009

As the national debate on health care reform rages, the University of Central Florida this week launched a new program that will prepare students for jobs considered essential to

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NCG Medical Donates $1.25 Million to UCF HealthCare Informatics Program

04/12/2009

Altamonte Springs, FL

ORLANDO, FL– April 12, 2009

NCG Medical, an Electronic Health Records (EHR) company based in Central Florida, has donated software and technical support valued at $1.25 million over five years to the University of Central Florida.

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NCG Medical’s dChart EMR Receives CCHIT Certification

02/28/2007

Software complies with 100 percent of certification criteria.

Altamonte Springs, FL

The Certification Commission for Healthcare Information Technology (CCHITSM) today announced that NCG Medical is CCHIT CertifiedSM for its product, dChart EMR and meets CCHIT ambulatory electronic health record (EHR) criteria for 2006.

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New Software Integrates with Statewide Immunization Registry

03/31/2006

New Software Allows Florida Pediatric Practices to Upload Patient Records Directly to Statewide Immunization Registry

Altamonte Springs, FL

For pediatric practices utilizing the Florida SHOTS immunization registry, the days of manually entering patient data into the system are over.

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NCG Medical Announces Its Membership in the Microsoft Gold Certified Partner Program

03/22/2006

Altamonte Springs, FL

NCG Medical, today announced it is a new member in the Microsoft Gold Certified Partner Program, Gold Certification is the highest classification in the Microsoft Certified Program.

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NCG Medical Systems' software, services chosen by east coast medical

09/29/2005

Contract marks company's 25th new customer this year for immediate release

Altamonte Springs, FL

Medical practice software developer NCG Medical Systems, Inc. announced today that it has signed a contract with Orlando-based EastCoast Medical Network

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NCG medical systems voted no. 1 in customer satisfaction

07/14/2005

Altamonte Springs, FL

NCG Medical Systems, Inc. announced today that its Perfect Care® practice management software was ranked No. 1 in customer satisfaction, according to the
2004 Computer/Web Site Utilization survey conducted by the

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NCG medical, iqmax partner to offer physicians enhanced mobile healthcare solutions

07/12/2005

Altamonte Springs, FL

Going mobile assists physicians in providing patients better care.

Medical software provider NCG Medical Systems Inc. announced today it has signed a private label contract with IQMax Inc.

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