Month: September 2015

How is ICD-10 Going to Affect You Oct. 1?

September 23, 2015 Posted on Categories Billing Service, Cash Flow, ICD-10

by Michelle Tohill

 streaming The Lost City of Z movie

Oct. 1 is right around the corner, and we still don’t know exactly how ICD-10 is going to impact healthcare businesses. In fact, there is still some slight question about whether the CDC is going to pull back at the last minute due to readiness concerns.

 streaming The Lost City of Z movie

Here are some things you should know for your business in preparation for Oct. 1:

>> You must use ICD-9 codes up through Sept. 30; beginning Oct. 1, you must use ICD-10 codes.

>> If you don’t use the correct ICD-10 codes, you will not get reimbursed.

>> It may take time for your partners and providers to get on board, so even if you are ICD-10 ready, your cashflow may still be impacted due to their inability to provide the correct billing information.

 streaming The Lost City of Z movie

While it’s hard to say EXACTLY what will happen on Oct. 1, we do know that there will likely be a great deal of confusion and an overall slow-down in the medical billing and reimbursement industry for at least the first 90 days following ICD-10 implementation.

 streaming The Lost City of Z movie

If you haven’t already, make sure your billers or billing service is fully ICD-10 ready, and prepare a cushion in your bank account to allow for significant cashflow slow-downs.

 streaming The Lost City of Z movie

Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

How to Avoid CMS Audits

September 11, 2015 Posted on Categories CMS, Documentation

by Michelle Tohill

No matter how confident you are in how you run your business, the phrase “you’re being audited” can strike fear into everyone. The idea of having a comprehensive analysis of your system is bad enough, but it’s even worse to think of the time that may be required to comply with the requirements of the audit process. Thus, although audits are very necessary parts of our healthcare reimbursement system, they are definitely considered a significant disruption.

 

Here are four ways you can avoid audits in the first place. Taking these steps will also ensure that you are fully prepared in case you ever do fall under the watchful eyes of CMS.

 

1. Verify eligibility up-front for every patient.

The ability to verify payment eligibility up-front, before you file a claim, is critical in maximizing your reimbursement rates and avoiding future audits. Additionally, if you went through the process of verifying eligibility, you have now created a paper trail documenting your system that will be helpful if you are audited. The right software system can make this easier by providing instant eligibility checks.

 

2. Review documentation to ensure proper ICD9/ICD10 & HCPC coding.

Before you ever file a billing claim, you should make sure that you have the proper coding. This is a time-consuming but necessary step to ensure that you are reimbursed appropriately for the services and products rendered. It will be a red flag if your coding is consistently off, as CMS may interpret that level of inconsistency as a part of how you do business.

 

3. Keep/scan your supporting documentation so that it is available if needed for an audit.

Always ensure that proper documents are being scanned and provided to the billing department. Dated screen shots provide a good source of documentation, but whatever your system, make sure your record-keeping is meticulous so that if there are any individual questions it doesn’t spark questions for CMS and lead to an audit.

 

4. Educate your staff on required documentation to meet medical necessity requirements.

No matter how great you are as an individual, or how knowledgeable you are of how to avoid audit, at the end of the day your staff could be the main weakness in your business if they aren’t fully aware of the documentation and coding requirements. Talk with them regularly and monitor their execution of your standards to ensure they are taking the steps necessary to avoid audit.

 

Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

Contact Us

Bonafide Management Systems 241 Lombard St.
Thousand Oaks, CA 91360

805-908-2333 info@bonafide.com
Schedule a Demo