• Analyze rejected/denied claims – Your practice may experience claim rejections/denials from time to time. You need to check if these rejections/denials occur rarely or they are occurring regularly. If they have become a common thing in your practice and you have a denial rate above five percent, it means you need to study your coding, billing, and claim submission processes and analyze the reason for your denials. You should ensure that there is proper communication between the healthcare staff, people in medical coding jobs, and medical billers to make certain that the right codes are used for the procedures performed and they are rightly presented in the claims.
• Train staff adequately – For accurate assignment of medical codes to various diagnostic and other procedures it is essential that you train your personnel in medical coding jobs with the latest updates in the different coding systems. Not just the medical coders, but your physicians and other healthcare staff should also be aware of the latest updates and regulations related to documentation and coding. Ongoing training programs help the medical coders and other staff to stay updated with the latest changes in the various coding systems thus, minimizing the chances of coding errors.
• Avoid interruptions – It is estimated that an average team member takes around 20 minutes to return to his/her task with full focus when interrupted. So, it is essential that you ensure your medical coders have no or minimal interruptions by reducing irrelevant team meetings and asking them to mute their social media notifications. This way, medical coders can concentrate on their work without any distractions.
• Limit non-coding tasks – Ensure that your medical coders are doing the work of assigning codes only. If they are playing dual roles by taking up some other additional responsibilities like scheduling, they would be unable to focus on their major task and this may affect their efficacy while assigning codes. As a healthcare facility, if you want correct reimbursements from your insurance companies or want full collections from the patients’ payments, you should ensure that your coders are doing the right job.
• Implement audits – Implement periodical coding compliance audits that can bring the coding issues to the fore and help you address them effectively. Keep your coders informed about the audits and make them understand that these are to improve the quality of coding and are not to assess and punish the coders.
• Outsource – To get the most efficient coding results, you may turn to medical coding services companies that perform the coding and billing tasks for you efficiently. By outsourcing your medical coding process, you will not need to track all the latest coding updates and train your staff as necessary.

Medical coding has a significant impact on your facility’s revenues and hence, you should take proactive measures to identify the issues in your coding process and rectify them. Above mentioned are some of the actionable tips you can practice to eliminate coding inefficiencies and deal with issues like staff shortage, etc. in your healthcare practice. Choose the best medical coding company and outsource your coding process for exceptional coding accuracy and efficiency.

EHR solutions facilitate documenting patient data in the form of electronic health records that are both economical and environmentally friendly. The data in EHRs which is accessible to authorized health care providers is critical in improving patient safety, quality of care, and offering evidence-based treatment. Hence, it is essential that people working with the help of hospital management software and EHRs understand the various terms used in EHRs. Here, we walk you through a few important and widely used terms in the documentation of patient data in electronic health records.

• Electronic health record – It is a comprehensive set of patient data inclusive of demographic, clinical, social, and financial aspects of a single patient stored in an electronic form that can be accessed by authorized persons across multiple health organizations.
• Certified electronic health record – A certified electronic health record is a health record that has been certified by the Office of the National Coordinator (ONC). The certification is awarded after reviewing and determining that the EHR is compliant with the technological capability, functionality, and security standards as required by ONC–Authorized Testing and Certification Body.
• Electronic medical record – This is a patient’s health record stored digitally that can be accessed by persons of a single healthcare organization.
• Meaningful Use – It is a federal incentive program by the Centers for Medicare and Medicaid Services that provides guidelines and regulations for healthcare providers with the minimum requirements that they must adhere to in the use of EHRs in order to be qualified for the payments.
• Health Information Exchange – This is a process through which patients and various people involved in providing healthcare (doctors, nurses, pharmacists, radiologists, etc.) get to access a patient’s critical medical information digitally across organizations as per nationally recognized standards. Sharing of a patient’s data through Health information exchange (HIE) facilitates high-quality and safe patient care at an increased speed while reducing costs.
• Interoperability – The ability of various health information systems within an organization or across multiple organizations to effectively deliver healthcare is referred to as interoperability.

These are some of the basic and most commonly used terms in the implementation of EHRs. Healthcare providers should choose the best EHR solutions providers to maximize their meaningful use purpose and implement EHRs with the highest levels of safety and accuracy. Choose nimble, one of the best providers of EHR Solutions in Hyderabad for your EHR requirements.

What is required at these times is mending the systems of electronic health records in totality going beyond interface issues and improving interoperability. The rebuild, process should capably address other issues that have been exposed by the pandemic crisis. The repair process of the electronic health records must allow focus on proactive management of health instead of enabling mere reactive sick care. As of now, the EHR systems are allowing us to maintain electronic health records that effectively keep track of the experiences of the patients regarding their health, i.e. they are tracking what already happened to the patients. But, to cope with pandemic crises and be ready for such tough situations ahead, we must incorporate the health aspect by introducing features in electronic health records that can help providers plan what they wish to happen in terms of health. Designing the EHR solutions should happen after considering such aspects which help in planning and tracking these ideas.

When electronic health records are developed as plan-centric, they would have a range of healthcare plans that can address a variety of patient health issues. For example, plans should differ for people who have large families and people who live all alone. Similarly, plans should be designed in such a way that an individual with more than one health issue is provided healthcare accordingly by bringing all relevant specialists under one plan and addressing the patients’ comorbidities collectively. This is significant because a person with comorbidities can develop serious health issues owing to multiple factors and healthcare providers should be provided with readily available data that can help them address such issues efficiently and save the patient from grave consequences.

Further, to help patients with comorbidities, the EHR solutions must allow interoperability of their plan as they may see different specialists and at different healthcare facilities. Simultaneously, the plan must keep all the specialists concerned updated about the patient’s changing conditions and remind all the users of the plan about the due or upcoming activities that are critical to the patient’s healthcare as a proactive measure.

The kind of EHR systems that are required by the healthcare providers must enable the physicians and other healthcare staff to analyze patient data accurately to discover any safety issues that a patient may have and identify unusual clinical findings to act upon appropriately in grave situations that are totally new or unexpected as in the case of the coronavirus disease side effects. Healthcare providers must invest in the right EHR solutions to provide the best healthcare to their patients.

To prepare the public for such crises in the future and tackle the present situation effectively, thorough research has to be taken up along with providing required resources to the public for their safety. This requires building a robust and scalable infrastructure that can process large volumes of data quickly and efficiently. Electronic health records (EHRs) have been a valuable resource in analyzing and mitigating the challenges of COVID-19.

COVID-19 is a severe respiratory disease caused by infection due to the SARS-CoV-2 virus leading to a wide range of disease severity with varied presentation and organ system involvement. To reduce the impact of prevalent misery, morbidity, and mortality, it is required that vast-scale scientific efforts are implemented. Although many people are seeing similarities between this pandemic and the previous pandemics, one major differentiator is the availability and use of several data sources including electronic health records.

The data pulled from electronic health records can help authorities and various parties concerned through –

• disease surveillance
• contract tracing
• risk evaluation
• real-time monitoring
• early detection of disease
• prevention and management of severe disease
• identification of risk factors
• recognition of complications

Further, electronic health records also facilitate by providing insights into the pathophysiologic process and help by serving as a platform for the utilization of artificial intelligence for the early detection, prevention, and effective management of pandemics.

To monitor outbreaks of infectious diseases, active surveillance, and contact tracing is implemented. Instead of going through a complex and time-consuming process of manually tracing the people who came into close contact with infected people, technological advancements can be leveraged that facilitate the use of several apps that use the mobile device data linked to the electronic health records. This can be utilized efficiently by educating the public to enter their data immediately into these electronic health records-connected apps when they test positive for the disease. This helps to alert other users if they were in proximity to the infected person during a particular period before testing positive.

Risk stratification is also a significant aspect of studying and mitigating the pandemic crisis. By deploying certain algorithms across electronic health record systems, government authorities and healthcare providers assess the number of comorbidities, multi-organ complications, and disease severity in people affected by the coronavirus disease. Such a kind of assessment of risk can facilitate early interventions in people with a high risk of disease severity and those who need ventilator support thereby reducing the risk of disease progression and mortality.

Further, the use of data from electronic health records can be efficiently used to understand the correlation between age comorbidities such as hypertension, diabetes, kidney disease, etc. to predict the risk of death due to coronavirus disease. It has been observed that aged patients with multiple comorbidities are at a high risk of severe illness due to coronavirus. The integration of certain algorithms with the EHR systems can facilitate the early detection and management of complications developed including myocardial injury, myocardial infarction, malignant arrhythmias, thromboembolic disease, etc.

It can be clearly understood that electronic health records consist of vital data elements that can help in responding to the pandemic crisis efficiently. Data from electronic health records can enormously help the authorities in making public health decisions and support various stakeholders including clinicians, researchers, administrators, and the public with authentic and real-time data. Healthcare facilities must pay attention to maintaining their electronic health records timely and accurate. For flawless and timely records, they can outsource the job to nimble, an EHR services provider in Hyderabad.

• Start right – You should start the procedure right by capturing the accurate demographic and insurance information of a patient. This is the first step towards an efficient billing procedure. The front office staff dealing with appointment scheduling and collecting patient data should ensure they are taking accurate information and verifying it before giving an appointment for a doctor visit. This helps in avoiding errors related to patient information at a later stage and collecting co-payments without hassles.
• Accurate and timely charges – Revenue cycle management professionals should ensure that they are making accurate and timely charges that help in collections without delays. A piece of important advice from RCM services experts is that at this stage, you should keep your fee schedule updated as per the latest changes applicable to government programs or insurance companies’ policies and procedures. Here, it is also significant that the medical billers closely coordinate with the medical coders and prepare the medical bills with the highest levels of accuracy. Another key aspect that you should not ignore while preparing bills is that your bills should be patient-friendly so that they don’t get confused with the complexity of the billing process and pay their part without delays.
• Accurate claims – The key to timely reimbursements and collections is the timely filing of claims. RCM services providers or the in-house medical billers should ensure that they submit all claims to the medical insurance companies within stipulated timeframes and follow up regularly with the insurance companies. Having a streamlined process in place for the follow-up of claims ensures that the claims are processed in a timely manner by the insurance companies and you don’t pile up your accounts receivables beyond the set timeframe.
• Communicating proactively – With the increase in out-of-pocket payments for patients in recent times, patients may find it challenging and confusing to understand and pay their bills. To make it easier for the patients, it is required that your billing staff communicate proactively with patients and make them understand the charges and the payment options available. This kind of communication from the staff will facilitate timely collections and avoid collection battles at a later stage.
• Managing denials – Your revenue cycle management process is incomplete without a denial management process in place. Per the research, it is understood that more than half of the denied claims are never followed up on by healthcare facilities. If you are one of those, you need to revamp your denial management process and ensure that you have a backup plan ready to deal with denied claims. If you are not equipped with the personnel to tackle denial management, it is advised to hire RCM services providers because your gains in the form of reimbursements received will outweigh the costs of outsourcing.

Make the right decision to train your employees and ensure that they follow the best practices. Else, outsourcing is a great option where the RCM experts identify and provide remedies to your billing flaws, thereby increasing your revenue cycle efficiencies.

• Implement the process: The first step in the revenue cycle process is implementing the RCM software or outsourcing the process to RCM services providers who are adept at handling the process with exceptional efficiency. For healthcare practices that have limited staff expertise or large organizations that have branches, outsourcing is the best approach so that they can focus more on their core job of providing quality patient care rather than worrying about financial matters.
• Patient access: This forms the basis for the entire RCM process where the effective functioning of the front office staff can minimize the claim denials and rework at a later stage. In this process, it is essential to check on the eligibility and benefits for patients.
• Pre-authorization: Prior authorization or pre-authorization is the next step in the revenue cycle process where the RCM services professionals have to obtain approval from the health insurer for the healthcare service, treatment plan, medications, or equipment to be used or performed that they are medically necessary for the patient. Pre-authorization is a pre-requisite for certain services with some exceptions in case of an emergency. However, one point to be noted is that pre-authorization doesn’t guarantee reimbursement of the cost.
• Claims submission: Payments for services performed will not be received until accurate claims are not submitted by the office. Practice management software comes in handy for the process of automatic claims submission. Where the RCM process is outsourced, the RCM services professionals need to submit the claims and ensure that they are flawless. In the case of any denials, the cause of denial has to be resubmitted post rectifying the errors.
• Reimbursement for services: Once the claims are submitted, it is time when the insurance payers have to reimburse for the services provided. The payers would verify the procedures with their charges and check the insurance coverage limit. They would check if the bills are accurate and reimburse for their services.
• Collections from patients: When the reimbursements do not cover the services provided fully, then for the outstanding amount the RCM professionals have to send the bill and follow up with the patient to collect the amount from the patients. Medical billers who are an important part of the revenue cycle process have to rigorously follow-up and ensure that the patients pay the total amount.

Performing all the steps properly and in a timely manner will help streamline the revenue cycle effectively. Every healthcare facility whether small or big will need proper revenue cycle management which can be provided by the RCM services providers.

Why RCM Process?

RCM process involving various aspects such as medical coding, medical billing, collections, and data analytics aids in the efficient running of a healthcare facility leading to better financial outcomes and improved patient care. Poor billing practices in a healthcare facility can lead to monetary losses resulting in a potential decline in the quality of care being provided; thus, it becomes critical for every healthcare facility to have a robust RCM process in place.

An effective RCM process ensures that right from the moment a patient comes to a facility for initial inquiry to the time when the final payment is received, the patient interaction is managed competently. The various aspects of the RCM process ensure that all the essential and appropriate information is collected and documented accurately aiding in billing only those services that are provided. Further, the RCM process enables contacting the payers or patients timely and collecting the due payments promptly avoiding denials and bad debts. After all, nobody likes bad debts and losses.

However, revenue cycle management involves multiple and complex patient interactions and mismanagement of any of these interactions can adversely affect the patient and clinical satisfaction scores damaging the reputation of a facility, halting its growth, and creating uncertainty for its financial performance. This is the reason every healthcare facility, irrespective of its size or health system, must prioritize revenue cycle management and revenue collection.

Steps of the RCM Process

• Preregistration: This is the first and most crucial step of the RCM process that allows a healthcare facility to collect important patient information including demographic data, insurance information, and eligibility for insurance. This step helps the facility check the patient’s insurance coverage, deductibles, co-insurance, and co-payments.
• Registration: This step further strengthens the aspect of collecting accurate information from the patient. The patient’s details such as phone number, address, date of birth, and insurance details are verified every time a patient is provided treatment regardless of whether the patient is new or established. This step, if performed diligently, can help avoid many issues at later stages.
• Charge capture: This is the step where medical services provided are transformed into billable charges. Accurate documentation of every service plays a critical role since these need to be submitted for payment from patients or insurance providers.
• Claim submission: In this step, information is sent to the insurance payer after entering the charges where it will be verified if the diagnosis and procedure performed are aligned.
• Remittance processing: This step involves applying or rejecting payments where allowable and write-offs are determined.
• Insurance follow-up: This is the step where the healthcare facility analyses the paid and unpaid amounts through the accounts receivables report.
• Patient collections: This is one of the toughest parts of the whole revenue cycle process where patient balances are determined and the amounts are collected from the patients.

A healthcare facility gets paid for the services delivered only when all these steps are performed diligently and accurately. Thus, the RCM process aligns the clinical care aspects with the business aspects and helps the healthcare facility function efficiently and successfully.

Build Your Career

Revenue cycle management is a key process for healthcare facilities and is a great career choice. Avontix, a National Medical company, is the leading RCM services provider catering to US healthcare facilities and offers rewarding careers in healthcare documentation, medical coding, medical billing, and AR calling.

Join the leading revenue cycle management services company and enrich your career with exciting opportunities.

 High-deductible Insurance Policies:

Let us see what high-deductible insurance policies are that are leading to collection challenges. For insurance plans, one needs to pay premiums. A high-deductible insurance plan is one that has a higher deductible than a traditional insurance plan. In such a plan, the monthly premium one has to pay is generally low; however, the policyholder has to bear more health costs (deductible) before the insurance provider starts to pay its share. Here, it’s necessary to understand what a deductible is. It is that portion of an insurance claim that the insured has to pay out of pocket and only upon paying this amount the insurance company will pay the other portion. So, from the healthcare facility’s point of view, when a patient with a high-deductible insurance policy is treated, the onus is on the billing department to collect the deductible from the patient.

High-deductible health plans are the only way to qualify for a ‘Health Savings Account’ that gives tax benefits. These plans are usually suitable for young and healthy people who generally don’t need health coverage with the exception of a severe health emergency. These can be opted for by wealthy people as well who are capable of paying the high deductible but want the benefits of the health savings account.

The rising popularity of high-deductible insurance plans is forcing some patients to delay paying their medical bills. In these difficult times of the pandemic when people are battling with not just health issues but employment and financial crises as well, collecting from patients has become a great challenge. This may result in an increase in money owed to healthcare facilities by patients and lead to bad debts over time.

In these tough situations, healthcare facilities must be careful in dealing with their account receivables and even consider sending their patients to collection agencies more quickly if they doubt them to be neglecting or trying to evade their out-of-pocket payments. It is even noticed that many healthcare facilities have started asking for payment before the service is provided to avoid collection issues later on.

Other aspects like claim denials are also adding to the burden of medical billers. Avoiding and managing claim denials effectively is essential to improve the efficiency of the revenue cycle of healthcare facilities. It is commonly observed that insurance companies can deny medical claims citing minute data errors and discrepancies. Sending accurate medical claims is of great importance because a denied claim costs both money and time for the medical billing department to resolve the issue. Submitting error-free claims is the best way to minimize denials and get your timely reimbursements, thereby improving your revenues. For this to happen, it is imperative to have a robust revenue cycle management process in place with adequately trained staff and cross-verification procedures in place, before submitting claims.

To achieve a healthy revenue cycle, healthcare facilities must either hire experienced and well-trained medical coders and billers or outsource their revenue cycle process to medical billing companies like Avontix, which offers exceptional medical billing services and help facilities focus on their core operations without worrying about their collections.

Is Medical Coding Career Dying?

No, medical coding is definitely not a fading career. Technology and artificial intelligence are indeed bringing about enormous changes to the medical coding profession, however, medical coding is a high-skill and human-intelligence-based profession. For accurate medical coding reports, there’s a high need for human analytical skills. But, it is also imperative that the current and aspiring coders should learn how to use technology to their best use and minimize the time spent on routine tasks.

Although medical coders have been specializing in specific areas for a long time, the demand is consistently rising for specialist coders and there is a great scope for market growth for such specialists. The nuances of various specialities and picking up relevant information from vast and detailed records require human analytical skills that are not possible with only technology-based coding.

Also, medical coders work extensively with protected health information (PHI) to communicate accurately with insurance companies. It is well understood that coders working with protected health information need to be completely familiar with and compliant with the Health Insurance Portability and Accountability Act (HIPAA), and thereby require having in-depth knowledge of HIPAA. Only human intelligence can balance the coding requirements and HIPAA compliance to provide timely and accurate coding inputs for medical billers and help prevent and reduce medical claim rejections and denials.

The major factor that influences the need for medical coders is that several grey areas cannot be classified under ICD codes uniformly by different coders. Medical coders use their analysis and judgment based on the information available to them and different coders can code the same procedure in different ways with a reasonable explanation. There are some issues that technology cannot solve aptly because some rules are contradictory, some descriptions are vague, and some instructions use soft language. The medical coding field is more related to the art of analyzing and interpreting than the mere science of applying codes rigidly.

Another factor that contributes to the choosing of medical coders over automation is that policies and regulations related to medical coding change frequently and only a human mind can figure out the exact and relevant policies and regulations while coding for accuracy.

So, although there is a scope for technology to take over human intervention in the medical coding field, there are still some aspects/issues that cannot be resolved with the currently available technological knowledge. It may take nearly two decades for technology to advance to a point where software programs are developed that can do medical coding without the involvement of a human brain and when an organization does not need a medical coder for its coding purposes. Hence, it can be said that medical coding will stay for some more time and aspirants can definitely choose a career in medical coding without any apprehensions. Avontix is one of the best medical coding companies in Hyderabad that offer excellent training and growth opportunities to its employees.

In such a scenario, clinics offer excellent small business opportunity to doctors but, management of clinics is a big thing because although the number of doctors available in a clinic would be low, there would be a steady stream of patients walking in making it challenging to handle the clinic tasks efficiently. Maintaining clinic premises, equipment, and very crucial patient records gets difficult for the clinic owner or management. Moreover, there are certain legal and statutory compliance issues that need to be met in order to avoid any kind of legal issues. To ensure that all clinical establishments provide certain minimum standard facilities and services, the central government has introduced The Clinical Establishments (Registration and Regulation) Act, of 2010.

As per the Clinical Establishments Act, various standards are prescribed for different types of allopathic clinics which include –

1. Standards for clinic/polyclinic only consultation
2. Standards for clinic/polyclinic with observation/short stay
3. Standards for clinic/polyclinic with dispensary
4. Standards for clinic/polyclinic with diagnostic support
5. Standards for dietary counselling centre
6. Standards for the hospital (level 1, level 2, and level 3)
7. Standards for mobile clinic-only consultation
8. Standards for mobile clinic with the procedure
9. Standards for mobile dental van
10. Standards for dental lab
11. Standards for physiotherapy centre
12. Standards for wellness centre – executive health check-up
13. Standards for integrated counselling and testing centre
14. Standards for speciality/super-speciality specific

Apart from these standards, the government has prescribed standards, some of which are in the draft stage yet, for the clinical establishments of –

1. Ayurveda
2. Homeopathy
3. Naturopathy
4. Siddha
5. Sowa-Rigpa
6. Unani
7. Yoga

The Clinical Establishment Act (CEA) is applicable in a majority of the states and union territories. The states and union territories where CEA is not applicable have their own Act. Doctors or people who wish to establish any kind of healthcare establishment have to follow the standards or guidelines as prescribed by the central government or the respective state government.