Helping Medical Practices Make More Money

Within changes in Current Procedural Terminology (CPT) codes and the implementation of ICD-10, many OB/GYN practices have faced medical billing and coding difficulties that have increased claims denials and slowed the practice revenue cycle. OB/GYN billing and coding comes with unique challenges because of the voluminous claims filing that comes with a practice that covers Obstetrics, Anesthesia for procedure, Gynecology, and Family Planning. If you’re practice is dealing with excessive claims denials that are hurting revenue, here’s a look at several strategies you can use to avoid claims denials and start improving revenue for your OB/GYN practice. 

Insurance companies and CMS will be expanding telehealth coverage, as well as refining the definitions of what constitutes telehealth care and provider qualifications and restrictions based on new laws. Here are some of the latest telehealth changes from state and federal lawmakers:

What is Population Health (PH)?

More than 50 percent of all deaths each year are caused by stroke, cancer and heart disease.Population health became a concern for providers and payers due to the need to rein in the incidence and subsequent costs of treating chronic diseases as well as a shift from fee-for-service to value-based care models. It has been recognized by CMS and others for some time that fee-for-service (FFS) is becoming unsustainable, whether from a financial or medical view. For example:

• Chronic diseases account for 7 out of 10 deaths yearly among Americans.
• Diabetes, one of the most common chronic illnesses, is the main cause for kidney failure, lower-limb amputations and blindness in adults between 20 and 75.

For a dermatology billing team one of the biggest headaches can involve Mohs surgery coding. While there are only a few codes for these procedures, knowing when and how to use them as well as modifiers or add-ons requires more knowledge and expertise than simply thumbing through the code book.

The reimbursement landscape is slowly but surely moving from fee-for-service to value-based in response to MACRA’s regulations, with their emphasis on quality of care, and the resulting changes in care delivery, as well as billing and coding. Major players such as Blue Cross and Anthem were reported to have paid close to 60 percent of their 2017 reimbursements through value-based contracts, with other payers moving in the same direction.

With CMS’s goal of fully 50 percent of payments coming through value-based contracts by 2018, its Quality Payment Program also moves this forward through incentive reimbursement based on outcomes. Looking ahead, Medicare payments to practices will either be increased or lowered up to 9 percent depending on value-added merits including outcomes.