payment – MD Update

&FRONT Accounting

Revenue Cycle Management (RCM) in Healthcare: Part 2

June 1, 2022June 22, 2022 Adam Shewmaker, FHFMA ■ analytics, ■ claim management, ■ claim submission, ■ patient statement, ■ start, ■ start of claim, â– , analytics, balance of the claim, bill, charge entry, claim denial, claim management, claim submission stage, claim submission stage of the process, clinical function, collection of patient service revenue, collection stage, credentialing, determine insurance eligibility, eligible payment, facet of care, full scope of patient care, healthcare, healthcare professional, healthcare revenue cycle, HIPAA, insurance, insurance eligibility, insurer, itemized list, itemized list of charge, MD-Update #139, opportunity, overview of the revenue cycle process, patient 's visit, patient care, patient collection stage, patient schedule, patient service revenue, patient-centered, patient-centered approach, patient-focused, payment, provider, RCM, RCM process, RCM strategy, RCM team, reduce claim denial, resubmission, revenue, revenue cycle, revenue cycle management, revenue cycle of claim, revenue cycle process, significant point of friction, silo, statement of financial obligation, strategy, uncertainty of expense, vital demographic information

Editor’s Note: Part 1 of Revenue Cycle Management was published in MD-Update #139, April 2022. It is available online at

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Revenue Cycle Management (RCM) in Healthcare: Part 1

April 1, 2022June 22, 2022 Adam Shewmaker, FHFMA additional insurer, apply payment, balance of the patient 's claim, big organizational roadblock, billable party, charge entry, claim denial, claim rejection, claim submission, clinical function, collection of patient service revenue, denial, denial management, determine amount, determine amount of reimbursement, determine cause, determine cause of claim denial, facet of care, full scope of patient care, healthcare, healthcare revenue cycle, insurance, insurance eligibility, insurance verification, insurer, medical appeal, medical code, patient 's claim, patient collection, patient demographics, patient insurance, patient registration, patient service revenue, patient-centered, patient-centered approach, payment, payment denial, provider, RCM, refund, revenue, revenue cycle, revenue cycle management, revenue cycle of claim, secondary claim submission, significant point of friction, submit claim, uncertainty of expense, universal medical code

Healthcare professionals strive to deliver exceptional service and outcomes to their patients throughout every facet of care. A significant point

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Provider Relief Fund Reporting Period 2

February 1, 2022April 19, 2022 Lance Mann, CPA, CFE, CGMA exist username, HRSA, https://prfreporting.hrsa.gov/s/), new guidance, new PRF report portal user, payment, period 2, portal, PRF, PRF payment, PRF report portal, PRF report portal user, provider relief fund, provider relief fund report portal, report entity, report period 2 fact sheet

The Provider Relief Funds Reporting Portal has opened for period 2. Providers who received one or more PRF payments exceeding

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Will You Be Surprised When the “No Surprises Act” Goes into Effect Jan. 1, 2022?

December 1, 2021February 15, 2022 Chip Dalton balance, balance bill, bill, bill staff, billed charge, commercial health plan, consent, consumer demand transparency, contracted rate, cost share calculation, CPI-U, determine cost share calculation, dispute resolution process, emergency, faith estimate, good faith estimate, health plan, healthcare treatment, in-network, in-network facility, in-network hospital, in-network plan, insurance, insurance plan, median of contracted rate, medical debt, member 's cost, member 's plan, new arbitration, new law, non-emergent service, out-of-network, out-of-network care, out-of-network claim, out-of-network emergency care, out-of-network emergency service, out-of-network hospital, out-of-network provider, out-of-network service, patient 's in-network, patient 's protection, payment, plan network, pre-authorization, president trump, provider, provider service, qualify amount, recognized amount, state 's medical bill law, submission process, surprise, surprise act, surprise bill

Patients have never been more concerned and affected by the cost of their healthcare treatment, as medical debt continues to

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Mandatory Reading

June 1, 2019September 4, 2019 James M. Schrader 20% add-on factor, add-on, area maintenance, Ask, budget purpose, Cam, commercial lease, commercial lease agreement, commercial lease center, common area maintenance, cost of janitorial service, expense, fine print, fixed rental obligation, footage, full-service lease, gross lease, guaranty, interior perimeter, janitorial service, landlord, language of the lease dictate, lease, lease agreement, lease center, lease dictate, lease document, lease term, major source of disagreement, mandatory Reading, measure tape approach, multi-tenant building, operate expense, operate expense of the building, operate expense of the property, payment, personal guaranty, recur common expense, recur common expense of utility, rentable square foot, rentable square footage, share of the common area, square footage, square footage of a commercial space, standpoint of an advisor, tape approach, tenant, tenant 's proportionate share, term of a commercial lease, triple net lease, usable square footage, zero-sum, zero-sum game

“Do you know the difference between education and experience? Education is when you read the fine print; experience is what

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Compliance: The Best Risk Management Tool

May 1, 2019June 21, 2019 Lisa English Hinkle abuse compliance, Anti-Kickback, Anti-Kickback statute, Anti-Kickback statute 's prohibition, behavioral health service, big data, CMS, commercial health insurance plan, commercial insurance rule, compliance, compliance area, compliance plan, compliance professional, compliance program, compliance program effectiveness, compliance review, complicated medicare payment rule, controlled substance, core element of a compliance program, data analytics, documentation, effective compliance plan, effectiveness of compliance plan, EKRA, eliminate kickback, employer, enactment of the eliminate kickback, evaluation of employee, ever-expanding area, ever-expanding area of compliance, everyday routine of regulator, federal report requirement, Fee schedule rule, filing, final physician, good practice, good risk management tool, healthcare, healthcare provider, HI-TECH, HI-TECH report requirement, Hinkle, important element of a compliance plan, important new area, insurance, insurance rule, internal report system, Kasper, Kentucky, Kentucky board, laboratory test necessary, match originating-site facility fee claim, measure compliance program effectiveness, Medicaid, medical necessity, medical record code, Medicare, Medicare claim, medicare payment rule, monitor adherence, necessity, new area, new area of compliance review, new criminal penalty, new enforcement, originating-site, originating-site facility fee claim, patient broker, payment, prescription of controlled substance, privacy, privacy requirement, program administration, protected health information, provider, provider education, recovery home, regulator, regulator 's sight, regulatory sea ebb, resource guide, review of big data, review of policy, risk management tool, robust compliance program, safety of patient, sample of area, score compliance, sea ebb, stark law, substance, substance disorder treatment, telehealth, telehealth claim, thorough documentation of medical record, tool, topic of a study group, ultimate risk management tool, vendor

What is compliance, anyway? Something that you will know when you see it? What is an effective compliance plan? To

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Hippocratic Medicine is Affordable Care

January 1, 2019 Cameron S. Schaeffer, MD $, $300 million dollar hole, 300, absence of price mechanism, affordable care, architect of Obamacare, bad manifestation, bad manifestation of third-party payment, basis of Hippocratic medicine, big incentive, called fascism, campaign-contribution, captured industry, cartel, cartel medicine, cheap facility, clinic system, Con law, concierge, continued existence of Con law, cost money, current medical system, debt, definition of a good gig, devalued currency, doctor, dollar hole, economic lunacy, education of doctor, employed physician, employed primary care physician, employer 's facility, fatal conceit, fatal conceit of Obamacare, free care, good deal, health cartel, high cost of cartel medicine, high price relative, high tax, Hippocratic medicine, immediate need of individual patient, insurance, insurance cartel, insurance company, insurance network, Kentucky 's budget, large clinic system, law of economics, law of scarcity, massive Medicaid expansion, Medicaid expansion, medical care, medical spend, medical system, medicine, moral pose, need law, nurse cost money, Obamacare, party payer, party payment, payment, physician, price tag, provider cartel, repeal certificate, repeal certificate of need law, sacred doctor-patient relationship, scarcity, socialized medicine, specialty referral in-house, specific CPT code, stuff, system subjugation, third-party payment, totalitarian neighbor, urologist, workarounds

Time to say it. Third party payment undermines the sacred doctor-patient relationship, the basis of Hippocratic medicine, and has been

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Physician Activity Now Under OIG Scrutiny: Revenue Impacts

September 1, 2018November 9, 2018 Shawn Stevison claim data, global period, global surgery period, incentive, item, new work plan item, OIG, OIG scrutiny, open payment data, open payment database, open payment program, payment, payment data, payment database, payment program, physician, physician activity, physician practice, post-operative service, practice pattern, proactive review of surgical case, receipt of incentive, required reported data, review of claim, review of post-operative service, surgery period, utilization pattern, work plan item

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) routinely issues new Work Plan items. This

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Identifying Revenue Leaks within the Medical Practice

October 1, 2017 Adam Shewmaker, FHFMA appropriate medical code, back-office responsibility necessary, bad debt collection agency, balance, balance amount, bill question, business office, cash, cash collection, cash post, chart documentation review, code audit, coder, compliance concern, cross-training, Dean Dorton, dedicated focus, employee, employee dread, employee dread take time, excellent staff, follow-up, high patient satisfaction, identify revenue leak, medical code, missed revenue, patient balance, patient balance amount, patient insurance, patient visit, payment, physician, physician inquiry, physician practice, potential collection, practice 's code habit, practice administrator, professional coder, profitable outcome, R follow-up, R., recent twelve month period, reimbursement, revenue cycle, routine medical code assessment, single cure, single point of data, small portion of the back-office responsibility necessary, staff concern, task, team member, underpayment, unique patient mix, work go

With reimbursement shifting towards quality care and patient outcomes, it’s necessary for medical practices to take a fresh look at

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Special Section

A Joint Effort

August 1, 2017 Jim Kelsey adult reconstruction surgeon, adult reconstructive fellowship, average age, BSN, bundled payment care initiative, bundled payment structure, care of the patient, clinic, CMS, cost save, CRRN, director of total joint replacement, Dr. Tharun Karthikeyan, effective orthopedic patient care, expectation, Famer, flat amount, flat payment, former Pittsburgh steeler, Gil Dunn, hall of Famer, hip, hip replacement, hospital stay, Jerome Bettis, joint effort, joint replacement, Joseph, Joseph hospital, Joseph hospital orthopedics, Karthikeyan, knee, knee center, knee replacement, leader of a cohesive team, Lexington, Lexington clinic, Lexington clinic orthopedics, Lexington repair, OrthoCarolina, OrthoCarolina hip, orthopedic surgeon, orthopedic surgery residency, orthopedics, outcome, patient navigator, payment, payment care initiative, photo, physical therapy, Pittsburgh, Pittsburgh steeler, positive patient outcome, posterior approach, procedure, provider, quality of care, reconstruction surgeon, replace knee, replacement, replacement program, RN, seminar, significant cost save, sport medicine, steeler, surgeon, surgery residency, Tharun Karthikeyan, therapist, total joint replacement, total joint replacement program, total knee replacement, trauma fellowship, unfair shift, university of Pittsburgh school of medicine

LEXINGTON Repairing and replacing knees and hip joints is what Tharun Karthikeyan, MD does for a living. He’s well trained

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