MDaudit announced today the release of Service Provider Workflow. This latest enhancement to its industry-leading billing compliance and revenue integrity platform supports billing when rendering providers differ from service providers, reducing audit risks related to the billing of split/shared services.
Under changes to its Evaluation and Management (E/M) guidelines, the Centers for Medicare and Medicaid Services (CMS) require split/shared services — which are performed jointly between a physician and a non-physician practitioner (NPP) in the same group and in a facility setting — to be reported by the clinician who performs the substantive portion of the patient visit.
To qualify for billing under the physician’s national provider identifier (NPI), which nets a higher rate than those billed by NPPs, the physician must have performed more than half of the provided care, as determined either by time spent or through evaluation of key components including history, examination, or medical decision-making.
“Service providers perform and document services under the supervision of the rendering provider. However, under current CMS E/M guidelines, the claim is no longer billed by the rendering provider unless they have performed a substantive portion of the care, which introduces a new layer of complexity and compliance risk into the billing process,” said Catherine Proctor senior product manager, MDaudit. “MDaudit’s new Service Provider Workflow functionality reduces that risk by allowing customers to include the service providers who aren’t on the claim as part of an organized audit.”
Users can efficiently organize line service providers into provider groups and audit both professional- and hospital-based service providers. It also features the flexibility to perform audits at the rendering, attending, or service provider level, organize audits at the line service provider level, and exclude cases from rendering/attending provider-organized audits when different line service providers are involved.
“The benefits of this new process are numerous, including a better root cause analysis for errors and the ability to provide feedback directly to documenting service providers while more easily targeting residents, ‘incident to’ providers, locum tenens, and split/shared services,” said Proctor. “Service Provider Workflow features were popular asks from the MDaudit community, and we are excited to deliver them to our clients to help further reduce their audit risk.”
Any doctor’s dream is to open a medical practice and to have patients line up the next day. Unfortunately, it’s a lot more difficult than this. A quick online search for marketing tips gives you hundreds of suggestions, but most don’t factor in the fact that the medical field is a unique industry. Patients don’t leave their houses to seek medical services from just any doctor, as building trust is a process. Here are tips you can use to market your medical practice.
Target the right audience
What conditions are you treating? Are you a consultant, a gynecologist, a pediatrician, or an obstetrician? If you are a pediatrician, you should market your business to mothers and fathers with newborns and toddlers. Your marketing message should be specific on services offered and expressed in a language that exudes professionalism and inspires trust. The information should drop the veil from the first word, leaving no room for second guesses.
Build a website
By now, you must have heard of Internet marketing, which entails establishing a presence on various Internet platforms. A website acts as an online version of your physical clinic. It contains all the necessary information on your practice, such as qualifications, licenses, recommendations, and services offered. It should also feature a blog showcasing success stories and free medical advice that links to your business. It is advisable to include access to answering services such as https://24x7doctorsansweringservice.com/ as they can effectively address patients’ inquiries in real time.
Network with other local businesses and professionals
Networking with local businesses is a great way to cross-promote your businesses. For instance, your medical practice can partner with a local personal injury lawyer like this Motorcycle Accident Lawyer in Duluth, GA, for the benefit of both of your businesses. They can refer injury victims to your hospital and vice versa. Networking and collaboration opportunities allow you to build a valuable pool of resources for your medical practice that you can leverage. Cross-promotional strategies you can consider include:
Healthcare has a vibrant startup and innovation ecosystem, but that doesn’t mean everyone shares the perks that come with technological developments. Historically, payors have often been ahead of the game in adopting and benefiting from new tech, forcing providers to play catch up.
But artificial intelligence (AI) is changing the game. A persistent trend I’ve witnessed is the steady rise of providers prioritizing technology – especially AI – to inform strategic priorities and address chronic headwinds such as staff shortages, increasing cost pressures, and slow reimbursement times, to name a few.
As healthcare leaders catch on to the enormous potential of AI to combat thorny issues, AI will take center stage next year, reshape the larger healthcare ecosystem, and begin to even the playing field between payor and provider.
As the end of the year approaches, here’s how I see this playing out in 2024:
Autonomous medical coding will be widespread — if not the norm.
The latest health IT report from Bain & Company and KLAS Research highlights the increasing importance of software and technology. Per the report, 70% of providers think AI will have a more significant impact on their organizations this year vs. last year, and an impressive 56% of those surveyed view software and technology as one of their top three strategic priorities, with revenue cycle management (RCM) coming in at a resounding first place. With many health systems focused on reducing administrative burdens for clinicians and a continued shortage of medical coders, autonomous coding adoption will surge.
Large language models (LLMs) like ChatGPT won’t work as advertised.
There’s plenty of commotion about the capabilities of language models, but they will likely disappoint when functioning as the core of autonomous coding engines. However, they will be enormously valuable in solving smaller pieces and edge cases, pushing coding automation rates to 100% for all the high-volume outpatient specialties.
The non-emergency medical transportation (NEMT) industry plays a crucial role in the lives of individuals with special medical needs. They often rely on NEMT providers to ensure that they arrive at medical appointments on time. Therefore, any delays or scheduling issues can lead to anxiety and frustration, as well as incur additional costs for the patient.
Aside from meeting patients’ transportation needs, NEMT providers must adhere to safety standards and regulations if they want to ensure their business’s long-term sustainability. Additionally, healthcare facilities and insurance companies are more likely to choose providers with a track record of dependable service.
That said, if you’re in the NEMT business, efficiency and reliability are paramount. This is why it’s important to constantly seek ways to improve your services for your company to thrive in the competitive market. Read on to learn some practical tips on how you can improve your existing NEMT services.
Implement Advanced Scheduling Software
As mentioned previously, NEMT providers need to be prompt when transporting patients to and from their medical appointments. That’s why implementing an advanced NEMT scheduling software is a good way to help revolutionize the efficiency of your operations.
This software automates the assignment of trips, optimizes routes, and adjusts schedules in real-time. It does this by taking into account factors like traffic, patient preferences, and vehicle availability. This ensures that passengers are picked up and dropped off as efficiently as possible.
By Dr. Benjamin Barlow, chief medical officer, Experity.
As we evaluate the healthcare landscape following the COVID-19 pandemic, particularly the urgent care (UC) industry, facilities have undergone significant transformation. Patient behaviors and economic factors have converged to reshape the way people perceive healthcare.
For urgent care, access to the use of reliable, accurate data is critical to inform intelligent decision-making and clinic success throughout dynamic market conditions and changing consumer preferences.
Part of this adaption centers around redefining expectations and benchmarks to measure success by leveraging data-driven insights to ensure that UC clinics continue meeting the evolving needs of their patient population.
Changing Patient Behaviors
In 2019, urgent care clinics were a familiar and reliable part of the healthcare ecosystem. Patients sought their services for minor injuries, illnesses, and a range of non-life-threatening conditions. During the pandemic, patients visited for COVID-related issues like testing, vaccinations, and respiratory care, but were hesitant to visit medical facilities for non-COVID conditions in fear of contracting diseases.
Now, UC clinics are vastly different as patient sentiment has again changed. This transformation can be attributed to shifts in patient behavior and the economic impact of healthcare decisions. Additionally, the end of the public health emergency (PHE) has stripped millions of Americans of their Medicaid coverage, further amplifying the issue of healthcare access, and adding to the uncertainty surrounding patient healthcare coverage.
According to a 2022 Gallup report, 38% of Americans delayed seeking medical care due to cost implications, marking a 12% increase from the previous year. This reflects the growing concerns surrounding healthcare affordability, having a profound impact on when and where patients seek medical attention. Rising deductibles, changes in insurance coverage, and the economic conditions following the pandemic have led individuals to reconsider their healthcare choices, often delaying care until conditions worsen and requiring costly emergency room (ER) visits.
The worsening of these cases is often preventable if patients seek care when they first notice symptoms, and UCs can help fill this gap as an alternative to an ER visit. With robust education through marketing initiatives, the value of a practice and the services it can provide throughout the community will ensure patients have the information needed to make educated decisions about their healthcare.
Oftentimes, medical facilities need to focus on preventing overstock and out-of-stock supplies needed to get their work done or when needed to provide their patients with the best care. But like any other business, sometimes, those much-needed items such as tools, supplies, or even something such as a medical file are temporarily misplaced and become lost until someone just by chance finds it again.
This clearly destroys productivity for everyone involved; you’re missing much-needed items, you’re missing information and issues that need to be solved have to be placed on the back burner until something is found again or needs to be reordered. There’s no room for these productivity killers in the workplace, especially in the healthcare sector, where a patient’s health is at risk. Plus, there’s potential for financial loss and compliance issues, too. So, what steps could a health business take to prevent losing medical supplies, tools, files, or anything else? Where? Here’s what you need to know.
You Have to Start By Implementing a Robust Inventory Management System
When it comes to any business, whether it’s in the healthcare industry or not, you’ll have to focus all on this first. Essentially, the foundation of preventing medical supply loss is a well-organized inventory management tool system. So, it’s best to go ahead and implement an electronic inventory tracking system that allows you to monitor stock levels, track usage, and set reorder points for critical supplies. Plus, you’ll also want to regularly update and reconcile your inventory to ensure accuracy.
Oftentimes, medical facilities need to focus on preventing overstock and out-of-stock supplies needed to get their work done or when needed to provide their patients with the best care. But like any other business, sometimes, those much-needed items such as tools, supplies, or even something such as a medical file are temporarily misplaced and become lost until someone just by chance finds it again.
This clearly destroys productivity for everyone involved; you’re missing much-needed items, you’re missing information and issues that need to be solved have to be placed on the back burner until something is found again or needs to be reordered. There’s no room for these productivity killers in the workplace, especially in the healthcare sector, where a patient’s health is at risk. Plus, there’s potential for financial loss and compliance issues, too. So, what steps could a health business take to prevent losing medical supplies, tools, files, or anything else? Where? Here’s what you need to know.
You Have to Start By Implementing a Robust Inventory Management System
When it comes to any business, whether it’s in the healthcare industry or not, you’ll have to focus all on this first. Essentially, the foundation of preventing medical supply loss is a well-organized inventory management tool system. So, it’s best to go ahead and implement an electronic inventory tracking system that allows you to monitor stock levels, track usage, and set reorder points for critical supplies. Plus, you’ll also want to regularly update and reconcile your inventory to ensure accuracy.
External payer audits quadrupled in volume in 2023, making timely responses more challenging than ever for resource-strapped healthcare organizations. Though patient volumes and surgeries have begun to recover from COVID-19 declines – with a 23% and 27% increase over 2022 – inflation, staffing shortages, reimbursement, and regulatory issues continue to jeopardize the financial health of healthcare organizations nationwide.
These were among the key findings of the 2023 MDaudit Annual Benchmark Report released today by MDaudit, an award-winning provider of technologies and analytic tools that enable the nation’s premier healthcare organizations to minimize billing risk and maximize revenues.
Ritesh Ramesh
“Increased complexity and reduced resources mean healthcare organizations are operating in an environment that demands flawless optimization for billing compliance, coding, and revenue integrity capabilities,” said Ritesh Ramesh, CEO of MDaudit. “Our analysis reveals the urgency for healthcare systems to stay ahead of the curve by harnessing digital initiatives and advanced technologies, including AI, machine learning, and analytics, to proactively manage compliance and revenue risks.”
Beyond technology, healthcare leaders must break down the silos between teams to create cross-functional/departmental synergies and manage change to stay operationally efficient. This will be imperative for growth and profitability going into 2024.
Shrinking Teams Face Growing Compliance and Revenue Integrity Challenges
Amidst nationwide healthcare staffing shortages, technology, automation, and analytics have emerged as critical catalysts for health system executives to drive change. Leaders are leveraging these tools to boost productivity, generate revenue, and control costs while compensating for reduced staffing levels. Managing denials and ensuring timely payments are important, but even more crucial is understanding and addressing the root causes of issues that start upstream with billing and coding practices in provider operations.
Across the MDaudit customer base, there was an increase in technology-driven productivity. Large auditing teams were able to accomplish 10% more in audit activities compared to 2022 with more or less the same resources.
Medicare Advantage plans were under constant scrutiny from the Federal government for compliance and overpayments. The data shows that these plans rejected 25% more in reimbursement dollars to providers this year versus 2022.
Telehealth remains a substantial contributor to compliance and revenue challenges. According to MDaudit data, telehealth volumes were flat relative to last year and an average of 30% of audits failed for services administered in a patient’s home or office. Proficiently coding and documenting these crucial charges is imperative for ensuring the ongoing success of patient care and favorable outcomes.
In 2023, external payer audits surged fourfold compared to 2022, often involving large audit documentation requests (ADRs). Mounting requests with tight deadlines and appeal timelines posed a significant risk of revenue loss and potential clawbacks, creating challenges for hospitals because of staffing issues.
Mitigating Denials to Protect Revenues
MDaudit’s findings emphasized the crucial role revenue integrity and billing compliance play in supporting the accurate and ethical capture and optimization of revenue for services rendered to patients. These teams are crucial for preserving financial stability, sustainability, and compliance, all while upholding the commitment to delivering high-quality patient care. Billing and coding are not about revenue alone; these cross-functional workflows directly influence patient experience and relationships, as well as a healthcare organization’s ability to grow.
Health systems are burdened by denials and increasing demand, underscoring the vital need for operational efficiency in billing, coding, and clinical documentation to enhance profitability.
The MDaudit analysis also found that:
Commercial payers are taking longer to respond to claims in 2023 vs 2022. Initial response times were 29 days (about six business weeks) for an outpatient claim and 35 days (about seven business weeks) for an inpatient claim.
MDaudit data for 2023 shows the value of commercial payers’ initial denials for professional claims has increased by 30% and by 5% for inpatient claims, as compared to 2022.
Medicare Part A and Part B rejected 16% of the claims initially submitted for outpatient services – the most profitable for healthcare organizations.
More than 60% of professional billing claim denials in 2023 were driven by documentation requests and eligibility concerns from payers.
“As we move into 2024, proactive actions and precision on billing compliance and revenue integrity outcomes are no longer optional. The healthcare landscape is evolving, affecting every facet of this industry,” said Ramesh. “New payer strategies and the integration of AI have intensified denials, payment delays, and claim scrutiny. How organizations and providers adapt and respond to these challenges will shape their long-term success.”
About the Report
The MDaudit Annual Benchmark Report equips compliance, HIM/coding, revenue integrity, and finance executives with industry insights, emerging trends, and data-driven information to help them take informed action and enhance outcomes for their organizations. The analysis in this report includes a comprehensive examination of data collected from a network of over 650,000 providers and more than 2,200 facilities that provide data to MDaudit for auditing, charge analysis, and denial assessment. This report encompasses insights from more than $5 billion in audited professional and hospital claims and denials by both commercial and government payers exceeding $150 billion.
MDaudit announced today the release of Service Provider Workflow. This latest enhancement to its industry-leading billing compliance and revenue integrity platform supports billing when rendering providers differ from service providers, reducing audit risks related to the billing of split/shared services.
