Helping Medical Practices Make More Money

With the consolidation of the Merit Based Incentive Payments System (MIPS) and other quality programs into the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), effectively abolishing the flawed Sustainable Growth Rate (SGR), implementation of these new changes and programs has caused plenty of confusion among various providers. As if staying on top of the latest medical trends while tending to patients isn’t enough of a challenge, tracking the various quality measures and scores is boggling to experts and practitioners alike.

A significant portion of your practice’s billable services is probably comprised of evaluation and management (E&M) services. Unfortunately, E&M Codes documentation, or lack thereof, is one of the big reasons for claim denials. Many clinicians fail to make the connection between poor, incomplete, or inaccurate documentation and falling practice revenue. Here’s a closer look at some of the common problem areas that may result in denials, and information on how to fix these areas to reduce denials and increase revenue. 

There’s significant room for growth for pain management centers today, especially since the American Academy of Pain Medicine estimates that more than 100 million Americans are affected by chronic pain, which is far more than the number of patients affected by heart disease, diabetes, and cancer combined. While there’s potential for growth, some of the pain management billing and coding challenges make it difficult to thrive. Successful billing and coding is half the battle when you’re trying to increase practice revenue. Avoid common billing and coding mistakes to make sure your pain management practice is poised to grow and thrive in 2019. 

As the holiday season rolls around, trauma centers, urgent care centers, and family practices are gearing up to deal with festivity-related mishaps. Thanksgiving, Christmas, and New Year’s are days of fun and good cheer. Unfortunately, the season’s festive activities also bring with them the risk accidents and illnesses. Luckily, there are a specific medical code for the holiday season! 

Managed care payments provide a significant chunk of revenue for many practices, so it’s understandable that most providers think twice and then some before cutting off any payers due to contract issues or other criteria. While practices should ideally strive for an open, collaborative and cooperating mindset when dealing with their payer counterparts, there are times when it’s best for the practice, and staff who must deal with issues by problem payers, to simply walk away and cultivate other sources of revenue.