Tag: health insurance

The 4 Most Common Reasons Your Practice’s Claims Are Bouncing

Posted on by VettersEnt

Billing can be time-consuming, tedious and frustrating to say the least. It can be even more frustrating when the medical claims that you worked so hard to submit are bounced right back. What are the most common reasons that a medical practice’s claims are bouncing back after submission?

Minor Errors

Just like it’s easy to miss a comma in an email or mistype a word, it’s also very easy to make minor errors in medical claims. Reimbursements are often denied or delayed due to seemingly-small mistakes, like forgetting to include a plan ID number or mixing up a letter. Because front desks are already so busy and overwhelmed, mistakes can fall through the cracks. One winning solution to this is using a professional outsourced claims processing service that will review claims before submission and look just for errors. The time saved from going through a resubmission is much less than time spent reviewing claims.

Missing Information

Another common reason that claims are bouncing is insufficient information. You always need to submit documentation to back up claims, and you should always supply each insurance provider the information that is requested to process payment in an expedient manner. Again, it is much easier to put the effort into properly gathering everything beforehand instead of needing to go back in the future to find the right documentation.

Skipping Authorization

If you needed authorization before a procedure was performed and it was not secured, you shouldn’t be too surprised that a claim bounced back your way. You should verify whether or not prior authorization is needed before you schedule the procedure. When it is time to bill, ensure that you also include the prior authorization number on the submitted claim. While prior authorizations can seem like an annoying extra step, they are vital to ensuring that claims receive approval in a prompt manner.

Changes on the Patient End

One of the most common reasons for claim denial isn’t necessarily your practice’s fault at all. Claims are often denied because a patient’s coverage has changed, the plan or payer has been changed or coverage has been terminated altogether. Even if you think everything is the same as the last time you spoke with a patient, you should always ask to confirm insurance information and see an insurance card at each appointment.

Trust the Experts at Vetters Enterprises for your Billing Needs

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

What PCPs Should Know About Asking for a Hospice Consult as a PCP

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Once you’ve determined that hospice care might be the best course of treatment for one of your patients, it’s time to formulate a plan to discuss hospice care and arrange for a hospice consult. Making that recommendation can be easier said than done, especially since hospice care has many connotations that go along with it. What do you need to know about hospice care for your patients?

What Is Hospice Care?

Whenever someone is facing a life-limiting illness, the goal of their medical care should be a team-oriented approach to care, pain management, emotional support and spiritual support that is customized to the patient. In surveys, many caregivers and families of terminally ill patients indicate that they would have liked information about hospice care when the diagnosis was labeled as terminal, not later in the process. While communicating this might not be comfortable, you should keep this in mind.

Delivering Bad News

One of the best methods for delivering bad news in the medical field is SPIKES. SPIKES represents a 6-stage process: set up, perception, invitation, knowledge, emotion and summary.

  • Set Up: Choose the right environment for the discussion and ensure medical consensus beforehand.
  • Perception: Ask the patient what they know about the illness and any information they already know. Ask the patient what matters most to them and what their wishes are. You should also ask if the patient has heard of hospice care and what they know about it.
  • Invitation: Ask the patient if it’s okay if you share information about hospice care with them.
  • Knowledge: Provide the patient with information before the hospice consult. Let the patient know that hospice can help them meet their goals of staying at home instead of going to the hospital, pain management and emotional support. Also, let the patient know what hospice care provides.
  • Emotion: Express sympathy for the patient. For example, “I know this isn’t good news to hear,” or “I’m sorry that I have to be the one to tell you this.”
  • Summary: When patients get a lot of information at once, it can be hard for them to process things. At the end of the conversation, ask the patient what they understood. You should also state clearly your recommendation that the patient have a hospice consult so they understand what the next step should be.

Recommending a Hospice Consult

You should determine whether or not a patient is eligible for hospice care. Medicare mandates that patients have a life expectancy of 6 months or less if the illness runs the expected course. You must be able to certify the terminal diagnosis and prognosis or re-certify them. To obtain a hospice consult, you must request it from a hospice service provider. The provider will evaluate the patient, determine eligibility and establish a care plan.

Practice Guidance for Your Practice from Vetters Enterprises

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

2018 Trends in Healthcare

Posted on by VettersEnt

It’s easy to get bogged down in the bustle of managing your practice—attracting new patients, keeping up with the latest in medical research and working hard to keep your current patients healthy. However, it’s essential to remain on top of the latest trends in healthcare and stay ahead of the curve. Here are the 2018 trends in healthcare your practice needs to know about.

Tackling the Opioid Epidemic

The leading cause of death for adults under 50 in the United States is now opioid overdoses. This epidemic is far too large for a single party to solve it, so everyone involved in the healthcare industry including prescribers, payers and the pharmaceutical industry, needs to band together to reverse this alarming trend.

A Focus on the Patient Experience

You’re probably sick of hearing about the importance of improving the patient experience, but this trend in healthcare isn’t going anywhere any time soon. As the healthcare market becomes more crowded and competitive, the efforts to improve the efficiency of the entire healthcare experience will dramatically increase.

Medicare Advantage on the Rise

Experts are projecting that Medicare Advantage will expand to cover a whopping 21 million people over the course of 2018, which is a 5% increase over the previous year. Your practice might see more patients with Medicare Advantage plans as a result.

Don’t Leave Mental Health Behind

As the social stigma around mental healthcare starts to dissipate, more and more patients will start to seek assistance for mental health struggles. Your practice should make a serious effort to understand the link between behavioral and mental health and tailor exams, including physicals, to address more than just the basics of patient health. Questions addressing technology use and the associated anxiety and depression, for example, are good screening tools for addressing the overall health of patients.

Using Wearables to Get the Bigger Picture

The wearable devices that many patients use, like Fitbits and other activity trackers, will start to be utilized by healthcare providers. Studies have shown that the most frequent users of wearable devices are less healthy than average and more likely to be hospitalized for health issues. These wearables can provide doctors with important information on patients and give a bigger picture of a patient’s health.

Partner with Vetters Enterprises for Information About the Latest Trends in Healthcare

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Tips for Surviving a Federal HIPAA Audit

Posted on by VettersEnt

Being contacted by the Department of Health and Human Services (HHS) or the Office for Civil Rights (OCR) for a HIPAA audit can be a very scary situation. The best way to survive a federal HIPAA audit is ensuring that you have the proper procedures in place every single day on the job. A single employee who is non-compliant could cost your practice a lot. 

Make Sure It’s Valid

Unfortunately, some scammers try to take advantage of practices by pretending to be OCR representatives conducting an audit and asking practices to purchase “certification” services. OCR and HHS will only make contact with your practice via email or certified letter. You always have a right to respond to ask for proof of validity, and that will not be held against you during the audit process. There is no certifying body for HIPAA compliance in existence, so any organization that approaches you claiming that they are one is lying.

Educate Your Employees

One of the best prevention strategies is educating your employees of the serious consequences of a HIPAA violation.

  • A HIPAA violation that occurs without knowledge: $100-$25,000 violation
  • A HIPAA violation due to reasonable cause: $1,000-$50,000 violation
  • A HIPAA violation due to willful neglect, but fixed within 30 days: $10,000-$50,000 violation
  • A HIPAA violation due to willful neglect that is uncorrected or corrected after 30 days: $50,000 violation

Reminding employees of the steep cost associated with each violation regularly can help to ensure compliance.

Tips for Survival

When preparing for a federal HIPAA audit, ask yourself the following:

  • Are our HIPAA policies and procedures regularly updated and effective? You should have things like a Breach Notification policy on hand and in effect.
  • Is our HIPAA training regularly updated and effective? How do we know it’s working? Every practice is required to hold HIPAA trainings for employees that are up-to-date, as well as maintain detailed records showing when employees attended the training and tests or surveys showing they understood the content.
  • Has our practice completed a risk assessment? This aspect of HIPAA often lies under the radar, but it’s a requirement as part of the HIPAA security management processes.
  • Have we had HIPAA breaches? If you have had a breach, you should make sure that all documentation has been properly completed.

Keep Your Practice HIPAA-Compliant with Vetters Enterprises

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

The Exciting Prospects of Pharmacogenomics

Posted on by VettersEnt

One of the newest and most promising developments in genetic testing could also help counteract the opioid epidemic. Pharmacogenomics is the practice of gene testing to determine how a patient’s body will react to specific medications. Pharmacogenomics is now covered by most insurances.

 

Genetics Affect More Than Previously Thought

Every person has thousands of genes that dictate their characteristics, from the color of their eyes to their blood type. As scientific research continues to advance, it is becoming apparent that genetics affect far more than was previously thought. Pharmacogenomics examines a patient’s genes for variations that may show whether or not a medication could be an effective treatment. Aside from helping to determine the efficacy of a drug treatment, this can also help to identify potential allergies before they occur.

The Basics of Pharmacogenomics Testing

The core purpose of pharmacogenomics testing is to determine whether or not a medication is appropriate for a patient. A patient will have a blood or saliva sample taken, and various tests will be performed to determine:

  • If a medication could be an effective treatment for the patient’s condition
  • What the ideal medication dosage should be
  • Whether or not an allergic reaction is likely to occur

Why Pharmacogenomics

Aside from the obvious benefits of the above, pharmacogenomics serves a variety of medical purposes. The study hopes to lead to drugs that are more customized to proteins, enzymes and RNA within each patient’s DNA. These high-powered medicines will do less damage and work more efficiently thanks to their customization.

The dosages for current medications will also become more accurate as height, weight and age will not be the only parameters. Instead, genetics will help customize the medication’s dosage, lower the chances of an overdose and help to reduce the likelihood of drug abuse.

Countless Patients Can Benefit

Depression is an incredibly common condition, and finding the right medication and dosage for patients is notoriously tricky. Pharmacogenomics could greatly assist with finding ideal psychiatric medications for struggling patients without the need for constant adjustments. With over 1 in 20 Americans suffering from depression, many people could stand to benefit.

Increase the Efficacy of Your Practice with Vetters Enterprises

Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

The Shift from Volume to Value: The Challenges

Posted on by VettersEnt

Now that we have covered the basics of volume-based reimbursement and value-based reimbursement and all of the wonderful benefits it will bring, we will address some of the anticipated challenges your healthcare facility might face.

In Case You Missed It

Healthcare providers are currently shifting from volume-based reimbursement plans to value-based reimbursement. This dramatic change is designed to benefit patients, healthcare providers and the payers. Value-based reimbursement promises to give patients the highest quality care for the lowest possible amount and shift the focus of healthcare providers to the actual health of their patients.

Medicare and Medicaid

As the baby boomer population grows older and more reliant on Medicare for their medical expenses, the reimbursements that healthcare facilities receive will decrease. In addition to the growth in Medicare patients, the use of Medicaid has also grown. The new mix of revenue will definitely take a toll on your office’s bottom line if you are not prepared.

Reconciling Volume-Based and Value-Based Payments

The next challenge healthcare providers face is reconciling the new value-based reimbursement model with your current fee-for-service environment. Tracking progress can be tricky, as you need to maintain detailed logging in two different payment systems at the same time. Your accounting systems and software might need a major upgrade in order to track value-based reimbursement patients, populations, and billing.

Keeping Track of Quality Measures

Most incentives for practices that meet certain value standards rely on keeping track of quality measures. You are probably already used to submitting some quality measures, but their effect on your bottom line might be new. The value-based reimbursement shift means that your ability to meet quality standards, benefit patients and cut costs is directly tied to whether or not you receive incentives or penalties.

This transition period is the perfect time to have an evaluation performed on your facility’s systems to see where you can further reduce costs and increase efficiency. Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.