Are you feeling STRESSED OUT?

With today being the day after “Tax Day”, many people are probably feeling the effects of the dreaded tax filing deadline.   Many others may attribute their stress to what they feel is the overload of their daily responsibilities and routines.   

What is psychological stress? 

Psychological stress describes what people feel when they are under mental, physical, or emotional pressure. Although it is normal to experience some psychological stress from time to time, people who experience high levels of psychological stress or who experience it repeatedly over a long period of time may develop health problems (mental and/or physical).

The National Institute of Mental Health states stress can be defined as the brain's response to any demand. Many things can trigger this response:

Change - The changes can be positive (marriage) or negative (divorce or illness), as well as real or perceived.  Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

Recurring, short-term, or long-term events - like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home.

How does the body respond during stress?

The body responds to stress by releasing stress hormones that increase blood pressure, speed heart rate, and raise blood sugar levels. Long term stress can cause:

digestive problems

fertility problems

 urinary problems

headaches

difficulty sleeping

depression

anxiety

increased susceptibility to viral infections

Ways to cope with stress are:

Maintain contact with friends and loved ones that can offer emotional support

Learn about relaxation stress management techniques

                                                                               

Seek counseling from a healthcare professional

                      Exercise regularly

3 Part Series: Medical Practice Vital Signs-Part 3

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

Previously in Part 1, we discussed the pulse of your practice: reviewing new patient growth and referral sources.  If you missed Part 1, please select this link: Check the Vital Signs of Your Medical Practice-Part 1

Following pulse, Part 2,  examined  blood pressure:  trending patterns of procedures billed and verifying proper claims reimbursement.  If you missed Part 2, please select this link: Check the Vital Signs of Your Medical Practice-Part 2

Our third and last vital sign is Temperature- 

What is the aging breakdown of your accounts receivable?

A basic Accounts Receivable report typically includes monies due in aging “buckets”:

Less than 30 days

31-60 days

61-90 days

91-120 days

121-150 days

Over 151 days

Ideally you want to see the largest percentage of receivables in the less than 30 days bucket with balances diminishing as you progress through the older buckets.  The older the receivables get, the more difficult it is to collect from the payer.  It can also snowball into an increasing amount of information to go through if not addressed in a timely fashion.  It can become so overwhelming, office staff may not know where to start.

Do you have adequate procedures to ensure quick collection of monies due?

Your receivables in the 31-60 days category, when analyzed by payer, can indicate if most of the money is based on secondary payer balances.  Due to the nature of processing turnaround time, it is not unusual to see secondary payer balances in this bucket and to some extent in 61-90 days also.  If you notice a large amount of primary payer monies landing in the 31-60 days bucket, checking the claim status with the payer is advised.  It could indicate the claim was not received by the payer and resubmittal is necessary in order to avoid those timely filing issues.  If you wait until they hit 61-90 days or more, it could be too late.  Claim denials should also be addressed frequently; if not daily as received by the payer, but at least monthly during the accounts receivable analysis.  Payers also have timely filing limits for appeals that are usually only 60 -180 days after the date of the EOB.  The quicker the appeal is sent, the quicker you may receive your reimbursement.

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Now that we have completed a review of the medical practice vital signs, adhere to the same recommendations you give to your patients.  Follow through with regular check-ups to maintain your practice health.  A medical practice management software like Iridium Suite has built in report scheduling to assist you in keeping that close eye on the pulse, blood pressure and temperature of your medical practice.                         
                                                                                  

3 Part Series: Medical Practice Vital Signs-Part 2

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

In Part 1, we addressed the pulse of your practice: trends in new patient statistics and physician referrals.  If you missed Part 1, please select this link: Check the Vital Signs of Your Medical Practice-Part 1

For Part 2, let’s check that Blood Pressure-  

Are the numbers of services you bill increasing, decreasing, or staying the same?

Depending on your type of medical practice, you could expect to see one or two procedure codes billed per patient visit or for some specialties like Radiation Oncology, you may bill 10 procedure codes per visit.  In either case, reviewing reports that show month-to-month statistics can allow you to recognize anomalies in your billing patterns.  Sharp declines in a certain procedure may indicate forgotten or missed coding opportunities and therefore missed revenue.  Many payers have time filing limits from the date of service.  They can range from 60 days to one year.  A regular review for missed charges will enable to meet those filing limits and collect on all of your rendered services.  If your report showed an unexpected procedure or an unusually high number of a certain procedure was billed, you will be able to audit the medical record(s) for appropriate documentation.  If billing errors are discovered, you can get ahead of an insurance audit by quickly refunding any payments received for these non-provided services.  Keeping yourself in the good graces of your payers is always important.

Is your claim reimbursement in line with your contracted fees?

This type of analysis is invaluable to any medical practice.  Once you have signed on that dotted line with the payer, you are wise to ensure that you are receiving the proper reimbursement based on the agreed upon contractual rates.  In the daily whirlwind of activity in the medical office, office staff seldom has the time to comb over the detail of every paid line item.  A monthly report that compares the payments received to the payer’s fee schedule will indicate payments that are below (as well as above) the payers contracted fees.  Payments that are below should immediately prompt a call the Provider Relations Department.  For payments above the contracted fees, research has to be done on the accuracy of the fee schedule you are using, for instance, perhaps the payer has updated its schedule and you have not.  This type of report could also make you aware of overpayments. If those are pre-emptively refunded to the payer, it will show your practice to be following proper procedures in the eyes of the payer.

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Be sure to watch for the upcoming publication of Part 3:  Temperature.

                                                              

3 Part Series: Medical Practice Vital Signs-Part 1

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

We will begin in Part 1 with the Pulse -     

How many new patients are you seeing each month?

By analyzing the trends month over month, you will be able to calculate your current growth rate and estimate the potential need for increased staffing and other infrastructure changes.  If close monitoring of your patient numbers shows a progressive decline or steep increase, it can give you the opportunity to research the reason why.  One reason could lie in the next item on our list, referrals.

Who is referring those patients to you?

With the almighty internet, physicians have been able to reach out much more easily and cost effectively to a wider range of patients.  While many people with basic medical needs may feel comfortable doctor-shopping online, there are many who have complicated issues.  These referrals generally come from colleagues and satisfied patients.  Know which providers in your area are referring patients to your office and always keep the lines of communication open in regards to those mutual patients.  A happy, well-taken-care-of patient is the best advertising.  Many times less than stellar office staff can scare away patients who “love” their doctor, and those unpleasant episodes can make their way back to the referring colleague.  Watch for trends that would show a reduction in referrals from a particular source and take the time to reach out personally.   

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Be sure to watch for the upcoming publication of Part 2:  Blood Pressure.

                                                      

Five Things to Know About Sequestration

Here are the five things you should know about sequestration:

1.  What is sequestration? 

It is the mandatory 2% payment reduction in the Medicare fee-for-service (FFS) program required by the Budget Control Act of 2011.

2.  Who does it affect?  

All providers of medical services that are reimbursed under the Medicare fee-for-service (FFS) program (i.e., Part A and Part B) are subject to the 2% reduction.  This also includes those entities that bill for durable medical equipment (DME), prosthetics, orthotics, and supplies.

3.  When does it begin?  

FFS claims with dates of service or dates of discharge on or after April 1, 2013.  Payments for DME, prosthetics, orthotics and supplies will be based upon whether the date of service, the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

 

4.  How is the 2% calculated? 

The reduction is taken from the calculated payment amount, after the approved amount is determined and the deductible and coinsurance are applied.

Example:

1. A provider bills a service with an approved amount of $100.00. 
2. Medicare normally would pay 80 percent of the approved amount ($100.00 x 80 percent = $80.00).
3. The patient is responsible for the remaining 20 percent coinsurance amount of $20.00 ($100.00 - $80.00 =  $20.00).
4. However, due to the sequestration reduction, 2 percent of the $80.00 calculated payment amount is not paid,       resulting in a payment of $78.40 instead of $80.00 ($80.00 x 2 percent = $1.60).

Billing Note:  The 2% reduction will be noted on the explanation of payment as Claim Adjustment    Reason Code 223.  (CARC 223 is defined as adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.)

 

5.  Where do I get more information? 

Documentation was issued by CMS on March 8, 2013 and can be found via this link:

http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-03-08-standalone.pdf

You can also contact your local Medicare Administrative Contractor for further information.