iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

Playing Santa gets doctors sued: Medical office holiday party liability


The holiday party season traditionally starts next week, right after Thanksgiving. Consider what your medical practice should and should not be doing at the office party to avoid liability. Despite the repeated warnings from myself and others, we inevitably get calls in the early part of next year from clients wanting advice about a problem that occurred and others calling too late to do anything about it. Here are ten simple safety tips. It’s an “office” party, so everyone needs to behave like it.  Standards of professional language, conduct, sexual harassment, and other rules in your employment policy manual  that control possible workplace



NY Health System Settles E&M Upcoding, Healthcare Fraud Case


Other recent healthcare fraud schemes involved a family doctor submitting false claims for unnecessary services and prison time for a healthcare CEO using kickbacks for referrals. A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding. According to the Department of Justice (DoJ), Health Quest Systems, Inc. and some of its subsidiaries allegedly submitted claims for E&M service levels that were not supported in the medical record. The health system billed the E&M services two levels higher than what the medical record indicated. “This



How PAs help practices in rural areas, during holidays


Some of the best providers I saw growing up in McCook, Neb., were physician assistants (PAs). After working in a lab for a few years, I decided that I wanted to be a PA, too. I wanted to diagnose patients on the front lines instead of reporting the lab results to the clinical team. Except for a short stint in Kansas City, Kan., I have chosen to work in rural areas, much like my hometown. Currently, I spend the bulk of my time in a family practice clinic but also work in the local emergency department (ED). The town I



Healthcare Revenue Higher for Practices Employing More NPs, PAs


Primary care practices with a non-physician provider to physician ratio of 0.41 or greater earned over $100,000 more in healthcare revenue, MGMA found. Primary care practices that employ more physician assistants, nurse practitioners, and other non-physician providers have greater healthcare revenue and productivity, the Medical Group Management Association (MGMA) recently reported. In its 2018 MGMA DataDive Cost and Revenue report, the industry group found that practices with a non-physician provider to physician ratio of 0.41 or greater reported higher expenses. However, the practices also had more revenue after operating costs compared to practices with provider ratios of 0.20 or lower. The comparative data



Revenue Cycle Management Outsourcing Market to Grow at 11.9% CAGR


The global healthcare revenue cycle management outsourcing market will see significant growth as providers aim to free up their resources while improving revenue. July 27, 2018 – The global healthcare revenue cycle management outsourcing market is slated to significantly increase, with its valuation rising from just $11.7 billion in 2017 to $23 billion by the end of 2023, a new market report shows. The authors of the report, The Market Reports, project the growth in the global healthcare revenue cycle outsourcing management market to increase at a compound annual growth rate (CAGR) of 11.9 percent from 2017 to 2023. Healthcare revenue cycle management outsourcing should



Four reasons to integrate EHR and practice management software


You have EHR software, and you have practice management software. But they aren’t on speaking terms. They don’t even speak the same language, and this language barrier may be doing more harm to your practice than you realize. Simply integrating these two systems can fix a lot of problems. If you’ve been hesitating to take the plunge, here are a few reasons why you shouldn’t wait. You’ll save time “Integrating medical records and practice management software cuts out a lot of duplicate effort,” says Laurie Morgan, a San Francisco-based senior consultant and partner with medical consulting firm Capko & Morgan.



A Poor Medical Billing Process Can Impact Patients


June of last year, we started reviewing every single statement prior to sending it out to the patient. We have pulled about 25 percent of those statements each month due to the patient payment and statement crossing in the mail; an incorrect patient cost-share implemented by the payer; coding or payment posting inconsistencies; or EHR issues. By pulling these statements, fixing any issues, and then re-running the statement, we have increased our customer satisfaction rate 10-fold. This was and still is the single greatest system that we implemented into our billing process. If you have all of your claims clean



3 financial metrics to drive better practice performance


“You can’t manage what you don’t measure.” This is so true in so many things we do in everyday life. But this is especially true if you are a doctor today responsible for the management of a medical practice. Unfortunately, too many physicians go to work every day unaware of how better reporting can drive higher performance of their medical practice. The good news is by understanding three simple indices and metrics, any physician can begin to dramatically change the financial outcome of a medical practice and realize the return on investment of their efforts and an increased valuation of



Most Physicians Will Not Drop Payer Contract Despite Poor Pay


Only 19 percent of physicians in a recent survey said they would get rid of a payer contract if the reimbursement was poor. Provider organizations should be monitoring their payer contracts to ensure fair reimbursement, but most physicians still would not drop a payer if they were paying poorly, a recent Medscape survey found. The poll of 20,000 physicians across 29 specialties revealed that just 19 percent of providers would back out of a payer contract if the reimbursement rates were poor. But the majority of respondents said they would not abandon the payer despite reimbursement performance. Twenty-two percent reported that they



Patient Billing Challenges Revenue Cycle Management


Organizations can improve revenue cycle management by making patient billing processes more automated by using a modern payment systems. May 20, 2016 – Patient payment and billing are significant revenue cycle management challenges that should not be ignored.  According to a recent survey conducted by Navicure, 63 percent of participants recognized that patient payment processes were “a high priority” for the healthcare revenue cycle. “It is important to reexamine existing workflows and processes to adopt a more effective, automated patient payments process,” the survey said. Patient accountability was also major concern for participants, who reported having difficult time collecting payment from patients. About one-third of survey respondents