Are your RCM Services Complementing Wound Care Practice Bottom Line?


It has been stated time and again that billing is the mainstay of every wound care program. Errors in billing can impact the bottom line quite drastically and must be avoided at all costs. Gathering demographic and insurance information at the patient’s first visit is a must. Tools and technology must be used to verify information. And the data must be entered in the system correctly. All these nuances if validated in time can reduce the revenue cycle by 30-60 days.

Checking wound care RCM services to ensure appropriate reimbursements:

Basics and audits: Accurate documentation needs to be maintained, else during audits money can be taken back from a wound care center. Hence accurate Medical billing and coding must be able to not just get the center paid timely; the center must be able to retain its earnings.

Relationship with finances (billing and coding): It’s imperative for physicians to not only focus on patient care, but also be in touch with the finances of the wound care center. The center must be updated about rules and regulations concerning billing and coding. Due to constant changes in the reimbursement process, physicians and the clinicians should be knowledgeable about accurate documentation, and other revenue cycle management processes. There must be a low denial rate, if at all. Further, there must be set processes to ensure the same denial does not occur in future. The charge masters must be set and at regular intervals, the entire revenue cycle of the wound care center must be reviewed.

Insurance and verification: As a patient visits the center, the healthcare staff must first and foremost verify the insurance information (as it tends to change often). Sometimes, a prior authorization needs to be conducted for a certain procedure. This is an important aspect for the financial success of a wound care center.

Diagnostic specifics: Coders must ensure apt documentation by physicians before they begin coding for wound care services. Coders must also be cautious while reporting excisional/non-excisional (operative/non-operative) debridement as this involves a number of procedures related to the tissue (devitalized tissue, necrosis or Clough). Coders need to view the documentation thoroughly and code as per the procedure conducted, the instrument, and the technique used for the wound care treatment. Further, providers must document all types of ulcers and their causes, precise location and depth of the tissue involved. The documentation must include level of debridement, description of the wound and pain areas/control, and response to the treatment- bleeding, hemostasis, dressings. Coders must not code for vacuum assisted closure; rather it should be done only for specific debridement. Coders also cannot code if the wound care is fundamental to another procedure (for e.g. do not combine graft/laceration closure to excisional debridement. And coders cannot code for multiple layers either, only for the deepest layer debrided.

Treatment: The notes must include wound dimensions, undermining or tunneling of the wound, wound base description, wound edges, tissue presence, drainage, odor, color, pain, changes in the wound, indications, ongoing treatment plans and next steps. Once the procedure is documented, coders must look for the treatment given. They must be aware of various types of treatment options apart from debridement such as topical wound care, off-loading, heel protection, controlling infection, local excision of lesion, debridement of open fracture, myectomy etc.

The wound care center must know at all times what they are getting paid; are there ways to treat patients which are less costly/cost-effective; does the documentation comprise details about services billed; do the claims reflect the procedures performed; the number and type of denials/rejections received and ways to prevent them. These questions are imperative to work towards a financially healthy wound care center.

Why Medical Billers and Coders (MBC)

As we approach the end of year-2017, it might be the time for you to calculate the Account Receivable (AR) for 2017 and have a better approach towards 2018. Medical Billers and Coders hold 17 years of experience in medical Revenue Cycle Management (RCM) with a skilled team coders and billers. Get a quote for your Wound care Specialty.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Wound Care Billing | Leave a comment

How to Increase Per-Patient Revenue Today?

How to increase per patient revenue today-.jpg

Stringent regulations and the ever changing healthcare environment often make it difficult for medical practices to sustain with profits.  Focusing on improving per-patient revenues is the main way of enhancing the practice profitability. To calculate per-patient revenue you need to divide the total receipts by the number of patients catered to. Here are some time tested ways to increase per patient revenue of your practice:

Systematizing your Resources  

Often lack of knowledge about the products available for sale can allow a prospective client to go unattended and an unsuccessful sales pitch. This will help to increase the revenues of your business immensely. Encourage and support your staff to obtain knowledge. For example, make sure your insurance specialist attends webinars and seminars about insurance updates, allow technician to attend classes to keep their certification up to date. Your goal should be ensure that all team members know of the capability of the practice.

Get Vendors to Demonstrate Need Based Solutions to the Staff

Have the manufacturing company agents demonstrate to your staff the benefits of products for offer and a brief course in sales. Being in practice a medical expert and his staff are well aware of the problems their patients face. Needs-based solutions are the approach where the entire team is recommends products that fit the patient’s needs. This allows the staff to be more involved with the patient. Vendors strategize ways to increase annual supply sales.

Early Diagnosis

Diagnose and manage diseases before they are moderate to severe. In most cases patients do not complain unless their suffering is severe. A smart practitioner is someone who asks the right questions to diagnose slight abnormalities before they become problems. This eventually leads to better patient care. Proactive management not only nibs the problem in the bud but also enhances per patient revenue.

Talk Per Patient Revenue at Staff Meetings

The entire staff should be well versed with the goals of the practice and the method to track them as each staff member directly impacts the total patient visit. Staff meetings can revolve around seminaries for the front desk in patient handling. The more knowledgeable each staff member is about their role, the more competent is the practice. Also, it is important to track and narrow down on the cause of low per patient revenue at the practice and then working on the ways to improve it.

Maintain Adequate Stock of Key Inventory

The trail of increasing per-patient revenue begins in the exam room with the doctor. Allow your practice to have a good selection of merchandise inventory. Most patients trust a clinic for making purchases due to the trust they place in their doctors.

Invest in Marketing

A general rule suggests that most new patients generate more dollars initially than returning patients. This is because a new patient seeks services for an immediate problem, and that is most likely why they have reached out for your services. You must also talk to your existing patients and ask for referrals. Turn your business into an online success story to reach out to a wider customer base. This will help in bringing in newer patients thus increasing the per-patient revenue.

 Why Medical Billers and Coders (MBC)

As we approach the end of year-2017, it might be the time for you to calculate the Account Receivable (AR) for 2017 and have a better approach towards 2018.   Medical Billers and Coders hold 17 years of experience in medical Revenue Cycle Management (RCM) with a skilled team coders and billers. Get a quote for your Wound care Specialty.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Medicare Medicaid, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

How Will Patient Engagement Affect Your Value-based Reimbursement?


Patient Engagement is an invitation for the participation with the shared decision-making and to create a take on aspects of communication-channels which will provide the patients the benefit of managing their own health under the care of physicians or with the member of the healthcare team. An activated or engaged patient will provide the healthcare system with a patient of better understanding and aware of healthcare problems.

Better patient engagement results in better value- based outcome with lowering amount adjusted, it creates empathy for the providers. Patient engagement results into knowledge-sharing and adds new environment for engagement.

Here are few insights on the patient engagement in value-based reimbursement:-

  1. Different process for engagement

Every patient is a person and mostly isn’t happy while coming to meet you. The patient is looking for care, usually; the care results in one-way communication. The patient engagement is close to zero.

Some of the beneficial factor for physicians

  1. Compliance benefited patient.
  2. Improved patient diagnoses and fewer no-shows.
  3. Better facility marketing.

A patient has a better engagement with physicians who are independent as it gives more time for you to spend with the patient for interaction and improve the engagement. For physicians working in a group, this could be the best reason to outsource medical billing so you can concentrate on your patient care.

  1. Better cost engagement

Improved care utilization and systematizing the most effective service for the patient according to each engagement will enable you to put forth a better value-based result.  It will also add the necessary preventive service for care that would cut down on long-term cost.

More data means knowledge resulting from data analytics for modeling the patient engagement which would predict the future patient engagement channels.

  1. Consistency in communication

You can be more proactive when it comes to approaching the potential group of employees or employers which might lead you towards in getting a wider range engagement for the practice. For a physicians group it’s easier with approaching a group of employees and then an insurance company, this would lead into building a consistent communication with a group of employees leading into better engagement with future patients on the value-based reimbursement for the procedures and diagnoses.

For a consistent communication between the payers- insures and patients along with physicians their needs to be a flow of information from both sides which would get the reimbursement flowing.

Practices can employ a strategy which is “Take the wheel”. Follow the recommendations given by the payers to small practices which take the lead on messaging the patients. The particular program or intervention that a payer of a small practice.

For Example, if a patient needs a cancer preventive program, the payer needs to cover it through out-of-pocket payment and the employer insurance will be willing to pay part of it. If all the stakeholders get in the loop even as the physicians want to see in continuous condition loop, and everyone benefits. The main example is to engage the necessary parties for better value-based care and patient engagement.

  1. Patient Engagement

Patient portals can act as a technology bridge between patients and physicians which would improve the service. The IT companies will develop an advanced function such as a more user-friendly app to encourage more engagement with user-friendly apps that encourage engagement and involvement.   This will not only promote your patient engagement it will also help you keep track of necessary components of patient care.

To improve your patient engagement under the value-based reimbursement model, you will need a team of billers and coders so that you promote your patient engagement without hampering your revenue.  For more info on medical billing click here or call us on: – 888-357-3226.

Posted in Accounts Receivables, Medical Billing, Medical Billing Company, Medical Billing Services, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment