How can Physicians improve AR days?


For you to improve the Account Receivable (AR) of your practice there are many different factors that come into consideration. Your quality of patient care is one such important factor which will contribute towards attracting more patients. To improve the patient care for your practice the things need to be systemized; we have to sync the work of an admin along with other patient care factors.

One of the easiest ways to achieve the complex goal setting of practice is to have a defined target and nothing can better than an Account Receivable (AR) of a practice?

A physician might say that yes I am seeing many patients but still my AR is low; one thing we ignore is the need of constant cash flow and collecting timely AR.

Physicians often come out on a short end especially when they are dealing with bigger insurance companies. Dealing with them requires a long length of time and skill.

Here are certain factors that would affect Account receivable days of physicians,

Aging of Claims: –

The first step that makes your AR clean is to determine the current status of payment for all of the AR. Create an AR aging report which will track your payment status. This will track or measure the number of AR days after the claim is submitted 0-30 days, 31-60 days, and 61-90 days. This can help you with tracking different potential collection problems and focus on the payment collection efficiently.

Claim submission: –

When submitting the claim it’s important that the claim is clean and complete with no missing information. While submitting a claim you should always look for small-denial-points that cause the insurance to deny the claims.  The silent nuances your claims generate will affect payment procedure.  For claim submission, you need proper channels which make it easy from the documentation, Charge entry, claim submission and AR.

AR strategy: –

AR strategy is one factor that will make your cash flow successive and channelized. At this point, you would need a team of callers or better to be said a team of AR callers come’s into the picture with friendly reminder call to insurance companies about AR due date. Your AR strategy should also include the keeping all your AR days below the threshold level of 90 days. This will help you maintain the status that all claims above 90 days will be put under daily check-status.

How (MBC) help you?

Now reading the above steps to improve your AR days would have cleared the picture for you that you need a team of experts who have handled medical billing before this and know how to reduce your AR days? Here comes a medical billing or collection agency which will provide you better control over your reimbursement. A collection agency will be a bridge between the payer and you. (MBC) a pioneering in practice collection with over 18 years under the belt we have structured many practices for growth. For more details go to our AR survey or call us on 888-357-3226.

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What do Providers and Medical Billers Need to Know about the Final MACRA Rule?

What do Providers and Medical Billers Need to Know about the Final MACRA Rule?

Indicating a departure from the volume based, fee-for-service model, MACRA now replaces the SGR – sustainable-growth-rate-formula to control Medicare costs. The MACRA rule is all about linking Medicare reimbursements to the quality metrics with the medical billers which will be now rewarded for offering value based quality services. MACRA revokes the set payment rates based on economic growth, which was the hallmark of SGR.

On April 27, 2017 CMS released a new proposed rulemaking for the MIPS and Advanced APM models. Physicians and the entire practice will now have an additional payment model. This makes it possible to determine the best model in terms of current performance.

After a payment model will be chosen, the physician will be responsible for determining how to organize themselves for biggest advantage with the choice they make. This requires an understanding of what’s required for success.

MACRA revokes Medicare Part-B Sustainable Growth Rate (SGR) reimbursement formula and now replaces it with Merit-Based Incentive Payment System. 85% of the Medicare reimbursements must be tied to the quality. To accomplish this, the health care providers should take part of an Alternative Payment Model or the Merit-based Incentive Program System.

What providers and medical billers and coders need to know about the final MACRA rule is now MIPS will measure Medicare Part B providers in 4 varied categories. The providers will be scored on a scale from 1 to 100. Based on their score, providers will either get incentive, will be penalized, or remain neutral.

Four categories of qualified clinician performance:

  • Quality 60% for 2017
  • Advancing Care Information which will be 25% for 2017
  • Cost 0% for 2017
  • Improvement activities (CPIA) 15% for 2017

Who gets affected by the new rule of MACRA?

All providers, including mid-level practitioners, who have at least 100 Medicare patients or who bill Medicare at least $30,000 per year, will qualify for MACRA. If you are new to Medicare in 2017, you will not have to report next year. You can begin reporting between January 1st and October 2nd, but all reports are due by March 31, 2018. The first payment adjustments will begin in January 2019.

How a small practice participates in MACRA?

Small practices can join virtual groups to submit MIPS data collectively if they do not meet the minimum volume for participation. The rule assigns $20 million for education and training for practices of fewer than 15 physicians and those in under-served areas.

Bottom Line

Ultimately, MACRA is going to require a great deal from practices. It’s a costly change that might not be able to be tackled by one physician or even within a single practice. More than likely, it’s going to lead to physicians beginning to team with other doctors. They may even join with an affiliating health system in order to take advantage of performance-based payment. As of the summer of 2016, doctors are collaborating to form clinically integrated networks, also known as CINs. A CIN is a group of physicians and health systems working together, and it’s going to be much more common as the year continues and even as the years pass.

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How is Drug Spending Affected in the Year 2017?

How is Drug Spending Affected in the Year 2017?

Per capita spending on prescription drugs in America is far more when compared to other countries of the world. Thus, Pharmaceuticals spending shares a significant and still growing share in the country’s healthcare expenditure. This constant surge in drug spending can be blamed on costly drugs that emerge from the labs and also because of prices of drugs that keep rising faster than prices of other goods and services. High end pricing of new drugs and rising cost of old ones has been an issue of major concern in the public and has been widely criticized by members of Congress and President Donald Trump. However, people are still waiting for tougher action by Congress to curtail or rollback price increases that far outpace inflation.  U.S. government pays more than 40% of the retail prescription drug tab, which has led to rise in spending on drugs consequently putting pressure on the federal budget. This is also a major reason contributing to rising health insurance premiums. Though Congress occasionally holds hearings trying to put pressure on drug makers, it is a step that is not enough to bring a change at the entire drug delivery ecosystem.

Drug spending has grown considerably since the 1980s. However, 2014-2015 was specific period of slow growth in the spending at drugs. This was because few major patents expired in 2014 and 2015, and when a patent expires and generic drugs enter the market, prices drop. Another reason was that several high-priced hepatitis C drugs like Harvoni, Sovaldi, etc made way to the market with sales in 2014 and 2015. This equaled to about 40 percent of the net increase in US spending on prescription drugs. Expensive new treatments for multiple sclerosis, diabetes, and cancer also were introduced leading to increase.

As per the reports published in American Journal of Health-System Pharmacy (AJHP) in the year 2016, national trends in prescription drug expenditures were projected to increase by 6 to 8% in 2017 across all healthcare settings. Predictions of this nature help health-system pharmacy leaders in planning drug budgets. Even Center for Medicare and Medicaid Services (CMS) estimates prescription drug spending will grow an average of 6.3% per year over the 2016-2025 periods.

When drug prices go up, everyone involved in the drug, trade, including the drug makers, pharmacy benefit managers, pharmacies, and in some cases, providers, all make more money. At the second time patients continue to be desensitized to super expensive drugs through copay coupons and out of pocket maximums well below the price of the drugs.

When Congress created Medicare Part D, it prohibited Medicare from negotiating with drug companies for lower drug prices. Congress also required eligible Medicare Part D plans to offer coverage for essentially all drugs in certain disease categories. Drug companies still face price pressure on drugs in the non-protected classes, though, because the private insurers that offer plans through Medicare Part D are able to negotiate. The exception is the U.S. Department of Veterans Affairs (VA), which negotiates prices outright and is able to exclude drugs from coverage, but accounts for only a small share of overall government drug spending.

It is observed that government is balancing two competing factors. It wants to give pharmaceutical companies financial incentives, encouraging them to innovate and produce breakthrough drugs; on the other hand it also wants to keep drug prices as low as possible. If the government allows drug companies charge hundreds of thousands of dollars to develop life threatening disease treatment, options, more companies will be willing to take the risks inherent in such an uncertain research project. But in this case annual costs will rise, due to rise in demand of life threatening disease treatment. The current system incentivizes drug research works as follows with normal 20-year patent term that applies to drugs from the time of the patent, usually before clinical trials are conducted. Food and Drug Administration (FDA) can grant temporary market exclusivity rights, providing a guarantee that the FDA will not approve a generic competitor for a set period of time. This implies that brand-name drugs have 13 or so years of sales before a generic competitor enters the market. The Market Share of generic drugs has grown so quickly over the past few decades because of the Hatch-Waxman Act of 1984, which incentivized generic drug companies to challenge brand-name drug patents, and also allowed generic drug companies to show that their drugs were equivalent to brand-name drugs before getting approval instead of requiring them to conduct a battery of expensive clinical trials.

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How providers must implement strategies to collect on outstanding patient balances?


As reforms continue to alter in the healthcare industry, it is affecting practitioners/hospitals, insurance providers and patients. Deductibles are increasing and the payments are increasingly becoming the patient’s own responsibility. Therefore, patients are becoming more involved and active regarding their insurance plans and payments which can at times be overwhelming for the practitioners to collect co-pays and other balances timely and accurately.

As per a report by SuccessEHS, 21% of the revenues from the patients are only collected upfront, implying that around 79% is left on the table. That’s a huge amount for any medical billing service provider. Hence, here are some strategies which must be implemented to collect patient balances on time to avoid any outstanding:

  1. Inform: The first time a patient calls for an appointment, it is the responsibility of the front-desk staff to inform the patient about his/her financial responsibilities and collect the co-pays before the service is due. Hence, the staff must be completely knowledgeable about the various policies implemented by the hospital. They should be able to check the patient demographics and accounts and remind the patient about the past-due balance (if any).
  2. Eligibility: It is before the patient visits the hospital for the service, the staff must be aware of the patient’s payment plan, health coverage, co-pays or other financial liabilities of the patient. This also aids in estimating the costs of services, which includes procedural charges, pricing between organization and insurance provider, patient insurance benefits etc. Finally, this will also enhance the chances of clean and complete claims, along with the reduction of denials, rejections or appeals.
  3. Appointment: In case the patient has not paid during his/her first visit to the hospital/clinic, it is best to collect the charges upfront when the patient schedules the next appointment. If not collected this time, it just may never be collected.
  4. Credit card information: If PCI guidelines and payers allow, the hospital can always keep credit card details for further payments. Co-pays can be made via HSA or credit cards.
  5. Financial options: Although all patients would ideally like to settle their bills on time, it is advisable for the hospital to make some financing options available such as EMI, discounts etc. through cheques, credit cards, debit cards, paypal, mobile applications or patient portals (for eg. a pediatric service may allow for some credits, say, for a sibling, to be transferred from account to another, which can eventually reduce the patients’ bill giving utmost comfort to the patient).
  6. Internal collections: It is best to collect dues internally rather than get into bad debt (less than $14 collected for every $100) and then move to third-party collection agencies. It is best to keep a tab on the number of reminders (letters etc.) as it costs money to send those too. Eventually, when the patient pays up (due to the retrieval body being a collection agency) to prevent their name being removed from the services, the original provider gets pennies for the dollar.
  7. Technology: Use technology to its maximum. Regular reminders or kiosks with information displayed about payments displayed all over on the hospital boards can avoid the need of asking the patient upfront to pay.
  8. Meetings: Also, it is advisable to meet with the staff regularly to monitor the payments inflow and find ways of for improving practice collections; and is essential to keep the staff motivated through incentive programs.

The healthcare industry is transforming. Though it is inevitable that there will always be unpaid balances and loopholes, it is vital to collect the revenues forthright. Practitioners and staff in hospitals work hard too, they must be given their due. For more Details about outstanding patient balances click here : or call us on :- 888-357-3226.

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Critical Trends Affecting the path of your Optometry Reimbursement


The industry of medical billing and coding is an ever evolving and developing industry. New advancements and techniques have totally changed the way medical billing professional perform their daily activities.

As of late, optometry practices have been compelled to change the way they bill and code for their procedures to comply with certain medical billing trends.

Here are three critical trends that have impacted the way medical billers provide optometry billing solutions:

  1. ICD-10

On October 1st, 2015 the tenth update of the International Statistical Classification of Diseases, otherwise called ICD-10 became effective under the Health Insurance Portability and Accountability Act or HIPAA. It supplanted ICD-9 and contains 71,924 procedure codes and also 69,823 diagnosis codes. Optometry facilities with in-house billing department had to learn these new codes, which in-turn hindered the productivity of many facilities.

But, what this change in ICD-10 has done is it has openly disclosed the inefficiencies of in-house optometry billers. This observation has led many practices to outsource their billing and coding undertaking to offshore agencies, which possess the know-how and expertise. Outsourcing optometry billing administrations has made it easier for Optometrist to put more focus on patient care and less on the implementation and adaptation of ICD-10.

  1. ACOs

An Accountable Care Organization or ACO is a voluntary group of healthcare service providers that cooperate to facilitate care to their Medicare patients. The primary objective of an ACO is to guarantee that patients get the right kind of care at the ideal time, while evading service duplication and preventing coding and billing errors.

Optometrists required in an ACO must guarantee that they are meeting consistence principles and have along these lines, exploited outsourcing optometry charging administrations.

  1. EHR

Although most of the Optometry facilities have embraced an Electronic Health Record software or EHR, some are still lacking in billing and coding integration. EHRs that have the features of billing integration make it possible for optometrists to streamline the way they get paid. They wipe out the requirement for optometrists to invest a lot of energy to fill out forms keeping in mind the end goal of payment collection. For leverage them with administrative burden, optometrists have turned to offshore companies dealing in optometry billing services.

As new innovations and regulations continue to transform the world of medical billing, more and more optometrists will invest in optometry billing solutions from a dependable medical billing company. If your optometry practice has found it challenging to keep up with the latest medical billing trends, contact today!!

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Tips to Calculate Payer and Gross Collection Ratio in Accordance with MIPS for Your Podiatry Facility

Tips to Calculate Payer and Gross Collection Ratio in Accordance with MIPS for Your Podiatry Facility

The net collection rate is an essential medical billing metric to measure the ability of your practice to collect the money it owes.

Podiatrists will not be able to succeed within the MIPS payment structure without a QCDR. While it is possible initially to continue to report PQRS via claims or using the method of “hand entering” data, submitting PQRS data via the USWR QCDR is what will allow podiatrists to use the Podiatry Specialty Quality Measure Group proposed by the APMA. The USWR also sponsored the APMA’s vascular screening quality measure and comprehensive diabetic foot exam quality measure, as well as 19 other wound care specific quality measures.

In addition for quality measure reporting, submitting data to the Podiatry Registry earns points for Advancing Care Information. The MIPS model is scheduled to begin in 2019, but 2016 is a crucial year. A provider’s performance in quality reporting programs in 2016 will affect the final MIPS score.

MIPS, the merit-based incentive payment system, use a score on a 100 point scale to grade your practice’s performance in four different categories. These performance categories include:

  • Meaningful use
  • The value-based modifier payment system quality as determined by the Physician Quality Reporting System standards
  • Use of vbm payment resources
  • Your clinical practice improvement

The points earned in each category will have a significant impact on the financial well-being of your practice.

The Centers for Medicare and Medicaid Services (CMS) has set a standard “performance threshold” of 50 points. You must satisfy at least 50 points to avoid paying a penalty. If your practice scores a 50, your payment adjustment will be 0 percent – generating neither penalty nor reward. However, if your practice scores 51 or above, you might receive additional financial compensation.

Payer Mix Ratio

It’s important to determine the value of an insurer to your practice. Calculate the ratio for each contract to determine how the individual plan or company contributes to your overall financial success.

If one or two companies dominate this statistic, make sure you develop the best possible working relationship with them. If you have a particularly hard-to-work-with plan which is responsible for a small percentage of your practice revenue, consider the possibility of terminating your participation with that plan.

Payer Mix Ratio = Individual Payer Receipts / Total Receipts

As an alternative to the Payer Mix Ratio, consider calculating the Payer Ratios. Replace receipts with adjusted charges. This ratio indicated what you should have received from various payers. When the actual collections differ significantly from what you should have collected, the problem often is the result of contractual write-offs.

Gross Collections Ratio

Gross Collections Ratio is a ratio that shows how much of what you bill is actually received. To make sense of this ratio you must compare it with the net collection ratio. This helps determine whether your fees are too high or low.

Gross Collections Ratio = Total Collections / Total Gross Charges

Net Collection Ratio takes into account your contractual adjustments with the insurance companies. The measure incorporates your contractual disallowances – how much of what you’ve agreed to be paid much how you’ve actually received. Be careful in calculating this. In posting disallowances (contractual write-downs) with each third-party payer’s reimbursement, don’t assume that whatever has not been paid is a contractual disallowance. MCOs and other payers (including Medicare and the Blues) often disallow more than what was contracted.

Net Collection Ratio = Total Collections / Total Gross Charges

Timely Filing of Insurance Claims

Podiatry Billing Services uses a clearinghouse to send claims to payers. Claims are processed electronically and are date and time stamped. The batch of claims is submitted to each insurance company for review and payment. If a claim is denied for timely filing and there is proof that the claim was timely filed, it should be appealed. The appeal should include the patient’s name, date of birth, date of service, policy number, ICD-10 Codes, charges, the date originally filed and accepted. Most payers take 30 to 90 days for review of appeals.

Deadlines for timely-filing can vary by state. Below are examples of timely-filing deadlines for some of the larger payers:

  • Medicare: 365 days from the date of service
  • Blue Cross/Blue Shield: 6 months from the date of service
  • Cigna: 90 days from the date of service
  • Medicaid: 95 days from the date of service
  • United Healthcare: 90 days from the date of service

For more information about timely-filing visit the payer’s website and look under the provider section for timely filing deadline. It’s very important to know the deadlines for carriers in your state. Holding claims can result in non-payment due to timely filing.

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