Access and Reimbursement

Reimbursement

Financing Technology

Billing Compliance

Audits

Accounts Receivable

Denials

Revenue Cycle Management

Billing & Collections

Value-Based Care

Personal Health Records

Coding & Documentation

Medical Billing & Collections

Overhead

Finance

Industry News

OSHA

Medicare

Medicaid

Healthcare Policy

Malpractice

Risk Assessment

Safety

MACRA

Opioids

Mergers/acquisitions

HIPAA

Embezzlement

Healthcare Reform

Legal Compliance

Contracts

Risk Management

Stark

Law & Malpractice

Social Determinants of Health

Technology and Patient Engagement

Patient Care

Marketing

Patients

Patient Portals

Patient Flow Wait Times

Patient Relations

Payers

Patient Dismissal

Patient Confidentiality

Patient Engagement & Communications

Practice Management

Retirement

Surveys

Practice 360

Locum Tenens

Practice360 Blogs

Practice360 Articles

Practice Expansion

Banking

Pharmacy

Healthcare Careers

Investment

Primary Care

Business

Salary

Safety and Error Prevention

Front Desk

Employment

Jobs

Managers & Administrators

Hiring Firing

Career

Mentoring

Staff

Staff Salary Survey

Self Pay

Scheduling

Training

Work/Life Balance

Residents

Operations

Outsourcing

Partnerships

Performance

Practice Models

Productivity

Recruitment

Red Flags

Practice Management Systems

Physician Productivity

Personal Finance

Physician Compensation

Referrals

Burnout

Staffing & Salary

Cybersecurity

Remote Patient Monitoring

Telemedicine

Vendors

Voice Recognition

Health IT

EHR Technology

Hardware

E-prescribing

Technology Survey

Stimulus

Mobile

Data Analytics

Technology

Topics

Media

Video & Interviews

Podcasts

Medical World News

Pearls

Best States to Practice

Great American Physician Survey

Conferences

ACP Internal Medicine Meeting

HIMSS

MGMA

All Conferences

Events

Virtual Events

CME/CE

Resources

Partners

Publications

Subscribe

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, 

Marketing Your Medical Practice-Ethically, Effectively, and Economically,

 which has sold over 225,000 copies and has been translated into Spanish. He contributes a weekly video for 

 on practical ideas to enhance productivity and efficiency in medical practices.  His 5–7-minute videos and short articles provide practical ideas that can be easily implemented and incorporated into any medical practice. Dr. Baum can be reached at 

Articles

The Narrative Medicine movement at Columbia Medical School believes that using stories increases empathy, enhances wellness and resilience, and promotes a more humanistic healthcare culture.

Storytelling to connect with your patients

 advises clients on compliance, transactions, government administrative actions, and litigation involving healthcare, cybersecurity, corporate and securities law, as well as False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

What health care can learn from recent DOJ actions.

Appreciating burden of proof and what remains in the SolarWinds case

Videos

How to make sure your practice's cybersecurity plans are enough to keep your patients' data is safe from hackers.

Keeping your practice's cybersecurity plans up-to-date and effective

a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

Growth has its risks, but the right strategy can deliver stability, security, and long-term profits.

Strategies to grow your medical practice

Physicians Practice offers practical, proven solutions to the real-world concerns physicians and medical practices face every day.

Advertise

Contribute

Contact Us

Privacy

Terms and Conditions

Do Not Sell My Information

Physician's Practice | Medical Practice News | Physicians Practice

Facebook

Twitter

LinkedIn

Spotlight: Career

1rem

Authors

Bruce D. Armon, a Partner and Chair in the Healthcare Practice at Saul Ewing, counsels clients on how federal and state health care laws affect health care providers and businesses.

The Report highlights the important role of MFCUs in investigating and prosecuting Medicaid provider fraud, patient abuse, and neglect, and the results of the MFCUs’ work, including in obtaining healthcare fraud criminal convictions, exclusions from federal programs, and civil settlements and recoveries.

HHS-OIG releases Medicaid Fraud Control Units 2022 annual report

HHS-OIG shares findings from its review of potential fraud, waste, and abuse in Medicare billing for telehealth visits in the first year of the pandemic.

OIG Telehealth report highlights issues from first year of the pandemic

Many schemes involve allegations of orders or prescriptions for medically unnecessary DME, genetic testing, wound care, or prescriptions for medication, each resulting in reimbursement from a Federal health care program.

HHS OIG warns healthcare providers of dangers of telemedicine fraud

The majority concluded that the mental intent requirement does indeed apply not only to the conduct in issuing a prescription but also to a prescriber’s awareness of whether the prescription is authorized.

Supreme Court requires more proof in controlled substances prescribing cases

As patient satisfaction plays a growing role in reimbursement, it’s critical for practices to find ways to boost patient satisfaction scores. But that’s easier said than done – especially since most practice staff and physicians are already stretched thin for time and resources.

To help, we spoke with Meryl Luallin, a partner at California-based medical practice consulting firm 

 and a medical practice shadow coach. Here’s how she said a practice can develop an effective patient satisfaction improvement plan.

Creating a patient satisfaction improvement plan

A step-by-step guide to improved patient satisfaction scores at your practice.

News

Why is medical information so valuable to hackers?

 are always trying to gain access to health care facility systems, but what makes health care data so valuable?

; cybersecurity, technology risk, and privacy practice global leader at CohnReznick; explains why hackers are so motivated to 

Why are hackers so motivated to gain access to medical data?

You know how much you have invested in your career and how much money it takes to run a medical practice, but your patients may not.

If you let patients know from the beginning that you are running a business and expect to be paid, you’ll have far fewer collections problems in the long run. Fortunately, having this conversation is not as difficult as you may think.

“We’re often embarrassed about collecting money, but we shouldn’t be,” says Kenneth Hertz FACMPE, principle consultant at 

 (MGMA) Health Care Consulting Group. “You can explain in a friendly tone that you are a business and want to be around for a long time provide care to your patients. That means you have to collect payments.”

Once patients understand this, they are more likely to pay their bills on time. But you do have to be consistent with this message.

“Most patients understand their obligations and are willing to pay,” says Elizabeth Woodcock president of Woodcock and Associates, a physician practice consulting firm. “A few are going to resist.” For those few, you have to make it clear from the outset that you expect to be paid in a timely manner.

This means having a billing and collections policy and sticking to it - no exceptions. “Often, the doctor tells the billing staff to collect what patients owe, but then tells patients not to worry about payment. I’m always hearing from staff [who are] frustrated by doctors making exceptions to the policies,” Woodcock says, adding that if patients learn they don’t have to pay, they never will.

Of course, you can - and should - still make arrangements with people who can’t afford to pay. But you must have a detailed policy for financial hardship, and every employee in your practice needs to understand and abide by that policy.

Setting expectations requires more than posting a set of billing policies. If you expect patients to comply with your policies, you must stick to those policies, too.

It would be nice to leave billing to the billing department and patient care to the clinical staff. But that’s not always possible.

Billing staff don’t know what’s going to happen before or during the visit. For example, a clinician may perform a procedure that requires an additional copay. “[Before] these things happen, someone from billing needs to come back and explain the extra charge to the patient,” says Karen Lake, healthcare consultant at the firm Pearce, Bevill, Leesburg, Moore.

Clinical staff need to be prepared proactively address these situations, too. The rise of patient consumerism means that patients are more aware of their care costs and are more likely to ask what they’ll be expected to pay for procedures, lab tests, and the like. Often, those questions come up in the exam room.

“Physician assistants and nurses deal with this all the time, so it’s a good idea if the billing department does in-service training so that the clinical staff have a better idea of billing and insurance issues,” Lake says. “They don’t need to know all the details, but they do need to know when to call in the billing department for clarification.”

The majority of patients take their financial obligations seriously. They value your services and expertise. They just need to understand what they are responsible for paying. It’s your job to explain that to them.

“The conversation doesn’t have to be all ‘Thou shall,’ ‘Thou shall not,’ and ‘We reserve the right,’” Hertz says. “Be up front, human, and matter-of-fact. It’s just a matter of person-to-person communication.”

If you let patients know from the start what you expect from them, you’re far more likely to get the money you’re asking for.

How to talk with patients about billing

When patients visit family clinics to address health issues, they expect quality care, and an easy billing process. However, these interactions can be stressful, especially when issues like incorrect patient bills arise. Such situations can be particularly challenging for individuals who are primarily focused on meeting their families' basic needs and may not have the bandwidth to deal with unexpected financial statements.

The frustrations experienced in healthcare settings, including 

 discrepancies, service levels, wait times, and other aspects of the patient journey, often stemming from underlying administrative challenges. Underneath their cool patient-centered focus, well-meaning healthcare providers are struggling with admin issues. A key contributing factor is the ongoing struggle to maintain an adequate workforce in the back office, which is essential for the smooth functioning of healthcare practices. This challenge is exacerbated by the current labor market dynamics, as highlighted in reports on the 

 rates continue to rise as insurance providers frequently alter their contracts, making reimbursement increasingly challenging. Healthcare providers lacking the administrative resources to meticulously review each claim and service find securing reimbursement from insurance companies increasingly tricky.

These three areas are particularly problematic, and addressing them is critical. The solution? A new introduction to the market, AI Agents, offer a promising pathway for family clinics and other healthcare providers to mitigate claims denials, enhance reimbursement rates, improve patient experiences, and refocus their efforts on core healthcare services. Healthcare back-office AI Agents are capable of various roles including:

Family clinics often handle a high volume of patients, including both scheduled appointments and walk-ins. Each patient comes with a unique reimbursement plan, making it difficult to determine their eligibility and available healthcare services quickly and on a large scale.

Reimbursement eligibility is nuanced and complex. It includes various factors such as an evaluation of the services covered by health insurance companies, the levels of reimbursement, and unique criteria that can qualify or disqualify a patient's services for reimbursement. This landscape is constantly changing as patients frequently switch insurance providers or plans, and their basic profile information, such as home address, may also change over time.

This complexity makes it difficult for family clinics to know what will be reimbursed, which leads to an unnecessary amount of claim denials without proper patient eligibility verification.

Thankfully implementing an AI Agent-powered eligibility verification function in their revenue cycle departments can help healthcare providers like family clinics. The AI Agent can sort through heaps of information quickly to verify each appointment and walk-in, ensuring that the services provided are eligible for reimbursement, and enabling them to inform the patients immediately if not, leading to improved patient satisfaction.

AI agents, offer a promising pathway for family clinics and other healthcare providers to mitigate claims denials, enhance reimbursement rates, improve patient experiences, and refocus their efforts on core healthcare services.

Bruce D. Armon

Articles

Latest Updated Articles