All physicians, other health care professionals, payers, and clearinghouses that submit HIPAA transactions will be required to use 5010 transactions as of the April 30, 2012 deadline. If these healthcare entities are not ready, they risk claim rejections and interruptions in cash flow. For most, this news should come as no surprise. However, some of the system changes that 5010 requires may come as a shock.... [More]

The manner in which the healthcare industry operates has changed significantly-- rising costs, rate cuts, additional Medicare beneficiaries, and increased standards and regulations. It is no surprise that Medicare laws are constantly changing, and with 2012 right around the corner important adjustments are quickly coming down the pike.

Each year plans change what they cost and what they cover—so when your patients come to you with questions, it is vital that you be prepared to answer. Here are some of the topics you should be prepared to discuss.... [More]

 

Flu season can be quite a headache for healthcare providers-- causing an enormous increase in billing activity and the number of Medicare claims that must be submitted. Due to a new vaccination requirement proposed by the Centers for Medicare and Medicaid Services (CMS), most providers are now required to offer Medicare and Medicaid patients an annual influenza vaccination. That being said, is your facility ready for the influx of patients who need their flu shots?.... [More]

Over the past few years The Centers for Medicare and Medicaid Services (CMS) has implemented a program to collect improper Medicare payments through Recovery Audit Contractors (RACs), waging a war against unprepared healthcare providers. In result, facilities across the country have had to gear-up for battle as the RAC soldiers continue their hunt for payment-perpetrators.

A nationwide survey of 200 healthcare providers done by IVANS found that 73% of hospitals agree that the RAC Program helps to reduce fraud and errors in the industry. However, more than 60% do not think the audit process is fair.... [More]

The deadline for transitioning electronic health care claims to 5010 standards is quickly approaching. Starting January 1, 2012 physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, remittance advice, and referral authorizations using the new 5010 standards. The rule requires providers to be more specific in what data is reported, collected and transmitted. The goal of the mandate is to improve reporting standards while enhancing the quality of care and protecting personal health information....
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Getting patient eligibility checked in real time is only important if your business wants to get paid for the services it renders. If revenue management isn’t a key component to the success and safeguard of your practice, you can continue to leave eligibility up to chance (and you can stop reading this blog post). But, if you are among the thousands of providers who are sick of wasting precious time and money verifying patient information over the phone and having to resubmit denied claims – this one’s for you.... [More]

Over the last decade, the healthcare landscape in the United States has dramatically changed -- with an aging population of baby boomers, incidences of chronic diseases on the rise, and patient costs and expectations steadily increasing. In order to create a more sustainable health system for the future, healthcare providers must adapt to provide more accessible, affordable and accountable care. But the question is…how?

Technology has moved to the forefront of many industries, and healthcare is no exception. The electronic capture and exchange of patient health information may be the essential first step our healthcare system needs. Many providers across the nation have taken this step by adopting Health Information Exchanges....

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