Does the Neurology RCM structure need a change owing to latest updates?

Do the increasing denial rates cause nerve tremors in the RCM cycle? For a proper revenue management, appropriate claims processing and collections are vital for healthy profit margins. But in these changing times of new rules & regulations by the Centers for Medicare and Medicaid (CMS), having a healthy profit margin to work with is essential for physicians specializing in neurosurgery. They need to proactively pursue every dollar besides streamlining clinical, operational and financial processes for optimal financial performance

As of April 2016, the new changes put forth by the CMS centers that aim to benefit neurosurgeons, could make or break the smooth flowing RCM process as at present which has just adapted to the change in ICD-10 medical billing and coding system.

This new payment system is based on Quality and has two paths defined - the Merit based Incentive System (MIPS) and the second is the Advanced Alternative Payment models (APMs)- thereby consolidating the 3 components of the earlier existing Medicare penalty programs - Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) and Value-based- Payment Modifier (VBPM).

Although, this is meant to create an opportunity for neurosurgeons to regularise payments with an improved medical billing and coding, it will also upset the just integrated and updated billing systems.

So changes in the Neurology RCM process will be needed where some challenges are foreseen in terms of:

• The Transition period: The need to update clinicians and the period of collection of updated data on which to set benchmarks needs to be integrated quickly, if not, this could lead to higher denial rates and affect the RCM, leading to inefficiencies.

• The Reporting Standards: These need to be re-modified based on the new standards set by CMS. The present reporting standards are demanding and burdensome and affect quality time given to patients which thereby affect the revenue flow.

• Negative payment Adjustments: This will affect the small and solo neuro practitioners. They need to find ways to succeed in the new quality payment program, given the new system, MIPS, that could affect their reimbursements and a fall in the revenue.

• Rules & Regulation changes: With the new CPT and HCPCS coding changes to be included soon in October 2016; regulations with respect to E/M services and how they affect the neurology practice; and, the CPT differences between a "qualified health care professional" and "clinical staff" - could all lead to errors in your medical billing and coding process affecting the RCM process due to increased denials and prolonged A/R period.

Thus, the RCM system of your neurology practice could be affected by the various changes that are coming. If not prepared and aware, then it's time to seek counsel from experts who are not only updated about the changes but also aware of how to integrate the changes into not just the medical coding and billing system but also work with the staff to build a robust and effective RCM process without causing a drop in your finances!

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Published By - Medical Billers and Coders
Published Date - Jul-07-2016 Back