Tag: Medical Collections

Changes in the Lab Industry Regarding Lowered Reimbursements and Current Challenges

Protecting Access to Medicare Act (PAMA) became a part of law on 1 st April 2014. The purpose of the act includes extending payments of Medicare physicians and other provisions. Instead of solving problems for healthcare facilities and clinical labs, these changes only complicated matters. PAMA introduced some vivid changes in the Medicare Clinical Laboratory […]

What Behavioral Health Providers Need to Know about Value-Based Reimbursements

Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers. Learn more about this important trend.Value-Based Reimbursements give In-Network providers an incentive to remain in a payer’s network, while tying a portion of their payments to patient outcomes. In doing so, the Value-Based system could help bring the cost of healthcare under control.And that’s not the only reason providers should embrace outcomes-based reimbursements. As of 2018 The Joint Commission will require outcomes-based data as a conditioned for accreditation. Other accreditation bodies are sure to follow suit.In this report, we look at how Value-Based Reimbursements, AKA “outcome-based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.Insurer reimbursements are changing once again. This time, payments are being tied to outcomes. We see this as not a “trend” but a long-term solution to the issues that have long plagued payer-provider relations, the biggest being the disparity between In-Network and Out-of-Network payments.Traditionally, In-Network providers received a reduced rate for services, with the trade-off being that insurers funneled more patients to their practices. Out-of-Network providers, however, could charge whatever they deemed appropriate. This meant a huge gap between what In-Network and Out-of-Network providers were being paid for the same service, and led to In-Network providers crying foul.In theory, Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers.In this report, we look at how Value-Based Reimbursements, AKA “outcome based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.

5 Reasons You Should Diversify Your Payer Mix

To run a successful healthcare practice, it’s important to diversity your payer mix. Here are 5 reasons why payer mix is more important than you thought. In Healthcare, having a solid and diverse payer mix can be the difference between running a thriving business and closing your doors. Having a diverse payer mix takes the power away from any one insurer. This gives you more control of your cash flow, and enables you to better predict how much money you’ll have at any given time.While this is a simple concept, it’s important to understand precisely how the differences in payer operations and guidelines can affect your practice.

Best Practices for Tracking Patient Outcomes in Behavioral Health

As healthcare evolves, there is a growing push toward rewarding positive patient outcomes through Value-Based Reimbursements, and using outcomes tracking as a condition for continued accreditation. In fact, The Joint Commission has announced that all members must begin tracking and assessing patient outcomes by January 1, 2018.But what should you track and how should you track it?

Improve Insurance Reimbursements by Improving Documentation

The entire business model of a substance abuse treatment center depends upon accurate, complete and timely insurance reimbursements.  Unfortunately, many treatment centers struggle to accurately and effectively document patient care in order to get the reimbursements they need to stay afloat.With that in mind, we put together this simple cheat sheet for improving patient documentation. For a more in depth look at this issue, we invite you to download our e-book, 3 Reasons Your Documentation is Costing You Money – And What to Do About It.

Three Big Reasons for Claims in Aging & How to Improve Reimbursements

Claim aging is one of the biggest issues in healthcare today – especially in behavioral health, where there is so much subjectivity when it comes to medical necessity. This is why it’s important for providers to understand why their claims go into aging – and what they can do about it.Here are the top three reasons for claim aging

Working With Multiple Vendors in Healthcare

In the healthcare industry, it is a common practice to give work to multiple vendors who specialize in their field. Sometimes you will be happy that you got something great done at a low cost. But have you ever thought of how many times you had to give briefings to each vendor to get your work done and how many times you need to follow up or call your vendors? Also have you noticed that you get different quality output from different vendors? Do you get all the outputs on time? I am sure the answer is NO. What if you can work with one vendor that can meet all or most of your healthcare business needs?