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5 Reasons To Outsource Medical Billing

Jose Carreras - Friday, December 15, 2017

Medical billing is an extremely important part of any medical practice, and it requires a special set of skills to do it properly. The fact that it has only become more complex over the past few years has led many practices to outsource their medical billing.


The following are five reasons why you should consider outsourcing your medical billing:


You will save money - Instead of having to hire your own medical billing staff, you can rely on a medical billing service, which can afford to hire the very best staff. You'll end up paying less for the same work because you won't have to hire specialized staff or pay for other related overhead costs, such as software and insurance.


You will make more money - You're more likely to receive higher collection percentages since less money will be erroneously adjusted off and fewer claims will be sent out incorrectly. Billing services are more experienced and skilled when it comes to appealing claim denials as well. Additionally, professional billing services will typically perform a fee schedule analysis as well to ensure that you're being reimbursed at the highest possible rate for your carriers.


You will be paid faster - A medical billing service will submit your claims at a much faster rate and with fewer errors, which means that you'll receive payments in a shorter amount of time. 


You will save time - A lot of time and effort can be wasted on medical billing when you could be focusing that time and energy on what you want to do - which is to care for your patients. Following up on a single claim can require you to spend a lot of time on the phone attempting to contact a carrier and dealing with high level management. A billing service will do these tasks for you.


You won't have to keep up with changing rules - The healthcare industry is regularly changing and it can be very difficult to keep up with all the new rules and regulations. A medical billing service will stay on top all of the new rules and regulations to ensure that your claims won't be rejected.


These are five reasons why you should seriously consider outsourcing your practice's medical billing to a professional medical billing service. For information about our comprehensive medical billing and collections services and how we can help your practice, be sure to contact us at ProMD today.

How The 2018 MACRA Proposed Rules May Affect You

Jose Carreras - Wednesday, December 06, 2017

In 2015, under President Obama, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Despite the procedural-sounding name, MACRA was written to be a disruptive piece of legislation intended to shift healthcare billing away from a simple "fee for service" model, and towards a more coordinated and outcome-based system.


This was scheduled to be implemented in several stages over the following years, and this summer, it passed a major milestone. The Centers for Medicaid & Medicare Services (CMS) issued a massive 1,000+ page proposed rule rewrite, primarily concerning how The Merit-based Incentive Payment System (MIPS) will work.


What's in it?  Here are some of the major items that ProMD Practice Management took note of:

1. There will be broad exemptions to MIPS.
MIPS is one of the most talked-about aspects of MACRA, allowing bonuses to be distributed -or denied- to clinics based on healthcare outcomes and patient satisfaction.  While not mandatory, many were interested - but in the current ruleset, only 36% of clinicians would be eligible at all. 

2. Virtual groups will be allowed.
To help single-specialty or single-physician practices to compete, MACRA will allow up to ten clinicians to band together and submit their data together, as if they were a (virtual) care center rather than a group of individual practitioners.

3. There will be MIPS bonus points for difficult cases.
One concern regarding MIPS is that it would "punish" physicians who primarily saw difficult or complicated cases, where they may have limited ability to affect the outcome. The rules account for this and award extra points in such circumstances.

4. EHR technology requirements are being lessened.
One of the more disputed recent regulations was the Meaningful Use (MU) program, intended to push faster adoption of EHR technology along an accelerated timeline.  Unfortunately, it seems the timeline was a bit too accelerated, and many clinics felt they were being compelled to adopt technology before it was ready - or readily available.  The new rules allow clinics to continue using 2014 Edition EHR products, although there are MIPS bonuses for those who have the ability to adopt 2015 Edition technology.

Medicare Billing Is Changing Rapidly - Can You Keep Up?


ProMD Practice Management is a provider of turnkey billing support, services, and consulting. We can take the burden of keeping up with billing changes off your shoulders, while improving your revenues.  Contact us to learn more.

Understanding the Recent ACA Executive Order

Jose Carreras - Friday, December 01, 2017

What the Latest Executive Order from President Trump Means for The ACA and Insurance Companies 

On October 12, 2017, President Trump signed a sweeping Executive Order aimed at altering and redefining certain aspects of the Affordable Care Act (ACA) in the near future.  This came on the heels of Congress failing to pass their own ACA reform, so the President was somewhat limited in the changes he could make.  Never the less, the executive order could potentially lead to significant changes to the ACA, particularly in terms of states' ability to set their own standards.

What sort of changes is this likely to make to the insurance industry?  Our ProMD Practice Management team takes a look. 

Unpacking the Impact of The Recent ACA Executive Order

The first and biggest change President Trump has initiated is this:  the Executive Order slashes the subsidies that were going to be paid to insurance companies to supplement ACA coverage costs.  This is due to a legal loophole.  The ACA, as passed, dictates that the subsidies should be paid, but does not actually authorize those subsidies.  So, the legal thinking goes, the government is not compelled to make those payments.

  • The impact this could have on the market is massive, and causing widespread concern.  Without the subsidies, the ACA becomes unaffordable for many insurance companies.  Many will undoubtedly raise their premiums to compensate, but others have the option to drop ACA coverage entirely.

  • Along with this, the Executive Order suggests (but does not mandate) that the Department of Labor loosen regulations covering Association Health Plans.  If enacted, it would likely mean more smaller businesses -or possibly even individuals- buying Association plans.  These plans are only loosely regulated, and not under the stricter regulation applied to ACA coverage, as well as generally providing less coverage.

It is likely some customers will opt to purchase these inexpensive health plans instead of paying for ACA coverage.  However, as these plans are largely intended for short-term coverage, it's hard to say how things will evolve if people stay on them long-term.

Assuming these changes go through without successful challenge - which is far from certain - there will likely be fewer ACA claims coming in, and potentially more private insurance coverage.

Get A Handle on Your Billing

Does it seem like you're spending as much time following political news as you spend reading medical journals?  Why not leave the politics to us? 

Contact ProMD Practice Management today to learn about our medical billing services.

2018 MACRA Final Rules

Jose Carreras - Tuesday, November 14, 2017

The 2018 MACRA (Medicare Access and CHIP Reauthorization Act) final rule was recently made available by the CMS (Centers for Medicare and Medicaid Services). The following are some of the things you'll want to know about the final rules so that you can begin considering future IT and organizational planning for your practice:

Increased MIPS Exemptions - The number of clinicians subject to the MIPS (Merit-Based Incentive Payment System) will be reduced to roughly 622,000. Last year, the CMS only exempted providers with less than $30,000 in Medicare Part B revenue or who saw less than a hundred Medicare Part B patients each year. This year, exemptions will be expanded to providers with less than $90,000 in Medicare Part B revenue or who see less than 200 Medicare Part B patients. These exemptions will help exclude 123,000 more clinicians from the MIPS.

Reduced MIPS Burdens - Small practices and groups that treat a bigger share of complex patients will receive bonus points that will help to ease their MIPS burdens. 

Continued Performance Year Flexibilities - Clinicians will be able to continue using the 2014 version of the CEHRT (Certified Electronic Health Record Technology) instead of having to update to the 2015 version this year in order to report Advancing Care Information transition measures. However, if you do upgrade to the 2015 version and use it exclusively, you could be eligible for a bonus score of 10 percent.

Increased Quality Performance Improvement Reports - The reporting period for the quality performance category will be quadrupled in 2018 to a full calendar year. Additionally, data completeness requirements will be increased to 60 percent for claim-based submissions, registry and EHR (Electronic Health Records). 

Factor in Cost Measure Assessments - The proposed rule initially delayed cost measure assessments until 2019; however, that has been changed. The CMS will now assess the cost measures of providers in 2018. Your cost category will now be factored as 10 percent of your MIPS final score and will increase the next year to be weighted by 30 percent.

These are some of the things in the 2018 MACRA that you'll want to know about. For more information about what the MACRA final rule entails and for assistance in remaining compliant with these new rules, be sure to contact us at ProMD today. Our practice management services can help you to remain compliant and to run your practice more effectively and more efficiently.

Outsource Your Medical Billing

Jose Carreras - Thursday, November 02, 2017

If you plan on outsourcing your medical billing, then you won't want to take the process of choosing a medical billing company to work with lightly. How fast your claims are processed and how much money you make on each claim will have a huge impact on your cash flow and net profit, which makes the selection of a medical billing services one of the most important decisions that you'll make.

The following are a few tips to help you select a high quality medical billing company:

  • Compare medical billing collection rate - You'll want to work with a medical billing service that has a high average collection rate. A high collection rate means that they most likely make few claim errors and have a good claim denial appeal process.
  • Compare medical billing process rate - Look for a fast average process rate. Medical billing services that have an average process rate of over four weeks are taking way too long. Look for an average process rate of around three weeks - this ensures that you get paid quickly.
  • Compare experience - The more experience that a medical billing company has within the industry, the more indicative it is of their quality. A company that lasts that long within the medical billing industry must be doing something right. Additionally, you should make sure that they have experience handling medical billing services that are relevant to your specific practice or clinic.
  • Compare functions - Look at the billing functions that a medical billing service can offer. At the very minimum, they should provide claim generation and submission services, carrier follow up services, payment posting and processing services, patient invoicing and support services and finally, collection agency transfer services. 
  • Ask about insurance - Ask what type of insurance each service carries. They are not only handling money, but also sensitive customer information. Ask what kind of coverage they carry, such as liability for security breaches and coverage for errors and omissions.
  • Ask about software - Ask what type of billing software they use and request details about whether it's cloud-based, whether it offers an integrated EHR, what their data backup and disaster recovery procedures are and more. 

Use these tips to select a good medical billing company. If you have questions about our medical billing services or would like more information on how we can assist your medical practice or clinic, be sure to contact us at ProMD today.

Reasons to Choose ProMD Practice Management Professional Services

Jose Carreras - Thursday, October 26, 2017

Why Choose ProMD Practice Management Professional Services to Boost Your Bottom Line

We founded ProMD with a simple premise:  Better billing leads to better care!  Your job is taking care of patients, while keeping up with the latest in medical research and best practices.  Why should you be dealing with billing concerns at the same time, when that can only distract from your core practice?  We take that burden off your shoulders, allowing you to focus your time and efforts where they matter most.

For over a dozen years, we have provided top-quality billing, collections, and professional support services to medical practices around the country.  We are aware there are plenty of other medical billing companies out there - but few can offer the same range of services, and track record of success, as ProMD.

What Sets ProMD Apart from Other Outsource Medical Billing Providers

1. A Proven Track Record
We first established ProMD in 2004 and since then, our company has only grown as we've brought more and more clients into our system.  The range of expertise we have on staff gives us more flexibility to deal with a wider variety of situations, and the result is that we consistently increase our client's collections by a minimum of 6-8%.

2. A Full Circle Approach
We aren't merely a billing outsource service.  Our "Full Circle" philosophy means we work with you directly as a consultant as well as a service.  We'll assess your practice as a whole, looking for areas which can be streamlined, and advice on implementing better procedures.  We are always available to help you implement more reliable and more efficient systems which will boost collections as well as helping to improve patient outcomes.

3. Move Towards Paperless Systems - And Save!
We can help you implement paperless systems which will qualify you for EHR Incentive Payments.  Through either MediTouch or Intergy document processing services, you can reduce or eliminate your reliance on paper while bringing faster, easier document access to your entire facility.

4. We're Only Paid When You're Paid
You don't pay us a flat rate; our fees come from a percentage of your collections. This system incentivizes us to keep finding better ways to handle your collections and processing, while ensuring you keep reaping the benefits of our services.

Increase Your Revenues with ProMD

If your practice is bogged down in paperwork and billing, ProMD will turn things around. Contact us to learn more.

When to Hire a Medical Practice Consultant

Jose Carreras - Wednesday, October 18, 2017

Sometimes, you may find yourself in a situation where you need assistance with your medical practice in terms of solving a particular business problem or figuring out a way to maximize your return on investments. However, you may not want to take on additional employees for these purposes, nor do you want to outsource any work due to the costs and lack of control involved in doing so. In such a case, you should consider hiring a medical practice consultant.

What is a Medical Practice Consultant?

A medical practice consultant is a person or company that can analyze certain problems or situations concerning your medical practice and offer up advice in the form of solutions to those problems or ideas that can benefit your business. Good medical practice consultants usually have a lot of experience working with healthcare practices and have a strong understanding of the business. The difference between hiring a medical practice consultant and outsourcing is that consultants typically are highly specialized professionals. They provide targeted and measureable results within an established period of time, which makes them a good fit for short-term and/or project specific projects (e.g. Practice and/or Billing assessments).

Determining if You Need a Medical Practice Consultant

If you find yourself needing professional advice or assistance for a short-term project, such as strategic business planning, practice assessments, practice startups, insurance contract negotiations or coding audits, to name a few, you could benefit from the use of a medical practice consultant. Not only can medical practice consultants bring their experience and expertise to the table when dealing with such situations and projects, but they bring a fresh eye as well. If you're facing a particular problem that you're having trouble solving, it's often because you're too close to the practice to be able to view the problem objectively. A medical practice consultant could identify the source of your problem immediately as well as suggest effective solutions.

Utilizing a Medical Practice Consultant

When hiring a medical practice consultant, you should resist the temptation to simply dump the problem onto the consultant's lap and let them take care of it. While this can be possible, it's a better idea to work with the consultant as a partner by collaborating with them closely. This will ensure that the work being done is consistent with what you want and what you need. Because the consultant is going to be someone that you'll work closely with and that you are going to trust an important part of your practice with, it's important that you hire a medical practice consultant that is reputable. The following are a few tips for finding a good medical practice consultant:

Find out how long they've been in the business - The longer they've worked as a medical practice consultant, the more effective they'll be. Not only is their experience a strong indicator of their quality, but it also means that they can recognize certain situations and problems and will know what solutions will work.

Find out what types of practices they tend to consult - Make sure that the experience that they have is relevant to your practice. The medical field is very broad, after all.

Determine if you get along - You'll want to work with someone you like and respect.

If you are in need of medical practice consulting services, be sure to contact us at ProMD today.

A Guide to Medical Practice Management from ProMD

Jose Carreras - Wednesday, October 11, 2017

3 Tips for Effective Medical Practice Management

By learning more on the steps your healthcare business can take to streamline its operations in the coming months, you can find new avenues for business growth. Our team at ProMD Practice Management has many years’ experience helping healthcare firms improve their operations by reducing costs and improving productivity, and in this latest post, we’ll help guide your organization forward with 3 tips for effective medical practice management.

1. Undergo a Practice Assessment

The first step in ensuring the long-term success of your organization is to undergo a structural assessment to determine where opportunities exist for improvement. It’s important that your organization undertakes a practice assessment to better evaluate its current processes and to learn where costs can be reduced throughout its infrastructure. The assessment firm will look at areas such as IT performance and billing cycles to determine how quickly bills are being paid and how effective your billing systems are at ensuring full payment in a short timeframe. This is just one area that can be improved in the assessment process.

2. Look for Billing Services

One of the most difficult challenges associated with management of a modern medical practice is having to digitize billing records for patients and ensuring that bills are paid quickly while following the latest regulations. Your medical staff have limited time to take on this process, and this means that they must turn to a specialist to ensure that billing work is completed professionally while they take on their medical work. Specialist billing service providers can also look to find ways in which to eliminate costs within the billing process and to ensure that patients pay their bills within a consolidated timeframe.

3. Follow the Latest Staffing Requirements

The needs of today’s medical services providers are continually changing. One week the company might be solely focusing on bringing in a new piece of equipment, the next they could be looking to integrate a new billing solution. It’s important that the company’s staffing matches their requirements. You should try to ensure that all staffing needs are met with precision. Look for open roles within the firm and for opportunities for expansion and then speak with local consultants about the types of staff needed to fulfill the company’s objectives in the long-term. To discover more on medical practice management strategies, contact our expert team at ProMD Practice Management directly!

Impact of ACA on Medical Billing

Jose Carreras - Wednesday, October 04, 2017

When the Affordable Care Act (ACA), which is also commonly referred to as Obamacare, was passed, it was obvious that it was going to have a big impact on all facets of the health insurance industry. A few years have since passed, and this has proven to be true - even when it comes to medical billing. So how exactly has the Affordable Care Act affected medical billing? 

How the ACA Has Affected Medical Billing

The Affordable Care Act wasn't supposed to make things like eligibility verification, pre-certification, medical billing and coding tougher on medical practices, but it did. The following are a few of the issues that have resulted from the ACA: 

More claims need to be processed - If the ACA has been successful at achieving one thing, it's to increase the number of people that have insurance. This is obviously a good thing. However, it also means that fewer people are paying for medical services out of pocket. More people have health insurance now, which means that practices need to file more claims. This, in turn, means that the billing process has become much more involved for most practices as a pure result of an increase in insured patients.

Coverage has changed - Almost all insurance plans have changed in one way or another as a result of the ACA. This means that there have been modifications in patient reimbursement rates and allowances. This has proven to be problematic in instances where the insurance companies have not communicated clearly with their customers, resulting in patients not realizing that the medical services that they've obtained may no longer have been covered or may only partially covered. This, in turn, has meant that more patients have needed to set up payment plans in order to pay off their balances.

Copays are more - Many insurance plans require larger copays or even require patients to pay a percentage of a medical service instead of a set copayment. This means that medical practices have had to get in the habit of communicating with patients before scheduled appointments to discuss or set up payment plans in order to avoid a growing outstanding balance.

Medical billing processes have gotten more complicated overall due to the ACA, which has led many medical practices to outsource their medical billing.

For information about our medical billing services, be sure to contact us at ProMD today.

A Guide to Minimizing Claim Denial

Jose Carreras - Thursday, September 28, 2017

4 Tips for Minimizing Claim Denial 

A claim denial can prolong the payment process and may even prevent your organization from achieving payment from the insurance company. One of the best ways to avoid a claim denial is to follow the guidelines offered by experts in the billing marketplace. Our team at ProMD Practice Management has decades of experience in the industry, and in this latest post we’ll highlight our four tips for minimizing claim denial.

1. Ensure Staff are Properly Trained

Your staff should be properly trained to respond to all billing demands within the office. They should know how to submit clean claims and how to follow all the latest legal guidelines while going through the claims process. For example, they should know how to select the right procedure and diagnostic code within their billing. They should also be able to verify the eligibility of patients before scheduling appointments. This can help to streamline treatment.

2. Choose Quality Claim Scrubbing Software

Claim scrubbing software can be critical to the success of a medical service provider. The claims scrubbing software helps to associate the patient with the code in the billing process. It works to identify any demographic information mistakes within the claim so that the claim can be processed normally by the insurance provider.

3. Outsource the Billing and Collections Process

Your medical team has a significant workload without having to tackle billing and collections work. They also might not have the expertise to complete billing and collections processes successfully. This might mean that your organization is missing out on billing revenue in addition to team productivity. Turning to a billing and collections specialist ensures that resources are used effectively throughout the organization. The process will help your business reduce billing errors and make sure that bills are paid promptly.

4. Have Regular Meetings on Billing Issues

You should meet with your staff on a regular basis to discuss billing issues and to determine how best to foster an understanding on billing and claims processing. Make sure that any challenges are met with a precise solution and that your billing company has an understanding on the current issues you face. Our team at ProMD Practice Management is here to guide you in reducing claim denial events. To discover more on your options, call us today!


5 Reasons To Outsource Medical Billing

Jose Carreras - Friday, December 15, 2017

Medical billing is an extremely important part of any medical practice, and it requires a special set of skills to do it properly. The fact that it has only become more complex over the past few years has led many practices to outsource their medical billing.


The following are five reasons why you should consider outsourcing your medical billing:


You will save money - Instead of having to hire your own medical billing staff, you can rely on a medical billing service, which can afford to hire the very best staff. You'll end up paying less for the same work because you won't have to hire specialized staff or pay for other related overhead costs, such as software and insurance.


You will make more money - You're more likely to receive higher collection percentages since less money will be erroneously adjusted off and fewer claims will be sent out incorrectly. Billing services are more experienced and skilled when it comes to appealing claim denials as well. Additionally, professional billing services will typically perform a fee schedule analysis as well to ensure that you're being reimbursed at the highest possible rate for your carriers.


You will be paid faster - A medical billing service will submit your claims at a much faster rate and with fewer errors, which means that you'll receive payments in a shorter amount of time. 


You will save time - A lot of time and effort can be wasted on medical billing when you could be focusing that time and energy on what you want to do - which is to care for your patients. Following up on a single claim can require you to spend a lot of time on the phone attempting to contact a carrier and dealing with high level management. A billing service will do these tasks for you.


You won't have to keep up with changing rules - The healthcare industry is regularly changing and it can be very difficult to keep up with all the new rules and regulations. A medical billing service will stay on top all of the new rules and regulations to ensure that your claims won't be rejected.


These are five reasons why you should seriously consider outsourcing your practice's medical billing to a professional medical billing service. For information about our comprehensive medical billing and collections services and how we can help your practice, be sure to contact us at ProMD today.

How The 2018 MACRA Proposed Rules May Affect You

Jose Carreras - Wednesday, December 06, 2017

In 2015, under President Obama, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Despite the procedural-sounding name, MACRA was written to be a disruptive piece of legislation intended to shift healthcare billing away from a simple "fee for service" model, and towards a more coordinated and outcome-based system.


This was scheduled to be implemented in several stages over the following years, and this summer, it passed a major milestone. The Centers for Medicaid & Medicare Services (CMS) issued a massive 1,000+ page proposed rule rewrite, primarily concerning how The Merit-based Incentive Payment System (MIPS) will work.


What's in it?  Here are some of the major items that ProMD Practice Management took note of:

1. There will be broad exemptions to MIPS.
MIPS is one of the most talked-about aspects of MACRA, allowing bonuses to be distributed -or denied- to clinics based on healthcare outcomes and patient satisfaction.  While not mandatory, many were interested - but in the current ruleset, only 36% of clinicians would be eligible at all. 

2. Virtual groups will be allowed.
To help single-specialty or single-physician practices to compete, MACRA will allow up to ten clinicians to band together and submit their data together, as if they were a (virtual) care center rather than a group of individual practitioners.

3. There will be MIPS bonus points for difficult cases.
One concern regarding MIPS is that it would "punish" physicians who primarily saw difficult or complicated cases, where they may have limited ability to affect the outcome. The rules account for this and award extra points in such circumstances.

4. EHR technology requirements are being lessened.
One of the more disputed recent regulations was the Meaningful Use (MU) program, intended to push faster adoption of EHR technology along an accelerated timeline.  Unfortunately, it seems the timeline was a bit too accelerated, and many clinics felt they were being compelled to adopt technology before it was ready - or readily available.  The new rules allow clinics to continue using 2014 Edition EHR products, although there are MIPS bonuses for those who have the ability to adopt 2015 Edition technology.

Medicare Billing Is Changing Rapidly - Can You Keep Up?


ProMD Practice Management is a provider of turnkey billing support, services, and consulting. We can take the burden of keeping up with billing changes off your shoulders, while improving your revenues.  Contact us to learn more.

Understanding the Recent ACA Executive Order

Jose Carreras - Friday, December 01, 2017

What the Latest Executive Order from President Trump Means for The ACA and Insurance Companies 

On October 12, 2017, President Trump signed a sweeping Executive Order aimed at altering and redefining certain aspects of the Affordable Care Act (ACA) in the near future.  This came on the heels of Congress failing to pass their own ACA reform, so the President was somewhat limited in the changes he could make.  Never the less, the executive order could potentially lead to significant changes to the ACA, particularly in terms of states' ability to set their own standards.

What sort of changes is this likely to make to the insurance industry?  Our ProMD Practice Management team takes a look. 

Unpacking the Impact of The Recent ACA Executive Order

The first and biggest change President Trump has initiated is this:  the Executive Order slashes the subsidies that were going to be paid to insurance companies to supplement ACA coverage costs.  This is due to a legal loophole.  The ACA, as passed, dictates that the subsidies should be paid, but does not actually authorize those subsidies.  So, the legal thinking goes, the government is not compelled to make those payments.

  • The impact this could have on the market is massive, and causing widespread concern.  Without the subsidies, the ACA becomes unaffordable for many insurance companies.  Many will undoubtedly raise their premiums to compensate, but others have the option to drop ACA coverage entirely.

  • Along with this, the Executive Order suggests (but does not mandate) that the Department of Labor loosen regulations covering Association Health Plans.  If enacted, it would likely mean more smaller businesses -or possibly even individuals- buying Association plans.  These plans are only loosely regulated, and not under the stricter regulation applied to ACA coverage, as well as generally providing less coverage.

It is likely some customers will opt to purchase these inexpensive health plans instead of paying for ACA coverage.  However, as these plans are largely intended for short-term coverage, it's hard to say how things will evolve if people stay on them long-term.

Assuming these changes go through without successful challenge - which is far from certain - there will likely be fewer ACA claims coming in, and potentially more private insurance coverage.

Get A Handle on Your Billing

Does it seem like you're spending as much time following political news as you spend reading medical journals?  Why not leave the politics to us? 

Contact ProMD Practice Management today to learn about our medical billing services.

2018 MACRA Final Rules

Jose Carreras - Tuesday, November 14, 2017

The 2018 MACRA (Medicare Access and CHIP Reauthorization Act) final rule was recently made available by the CMS (Centers for Medicare and Medicaid Services). The following are some of the things you'll want to know about the final rules so that you can begin considering future IT and organizational planning for your practice:

Increased MIPS Exemptions - The number of clinicians subject to the MIPS (Merit-Based Incentive Payment System) will be reduced to roughly 622,000. Last year, the CMS only exempted providers with less than $30,000 in Medicare Part B revenue or who saw less than a hundred Medicare Part B patients each year. This year, exemptions will be expanded to providers with less than $90,000 in Medicare Part B revenue or who see less than 200 Medicare Part B patients. These exemptions will help exclude 123,000 more clinicians from the MIPS.

Reduced MIPS Burdens - Small practices and groups that treat a bigger share of complex patients will receive bonus points that will help to ease their MIPS burdens. 

Continued Performance Year Flexibilities - Clinicians will be able to continue using the 2014 version of the CEHRT (Certified Electronic Health Record Technology) instead of having to update to the 2015 version this year in order to report Advancing Care Information transition measures. However, if you do upgrade to the 2015 version and use it exclusively, you could be eligible for a bonus score of 10 percent.

Increased Quality Performance Improvement Reports - The reporting period for the quality performance category will be quadrupled in 2018 to a full calendar year. Additionally, data completeness requirements will be increased to 60 percent for claim-based submissions, registry and EHR (Electronic Health Records). 

Factor in Cost Measure Assessments - The proposed rule initially delayed cost measure assessments until 2019; however, that has been changed. The CMS will now assess the cost measures of providers in 2018. Your cost category will now be factored as 10 percent of your MIPS final score and will increase the next year to be weighted by 30 percent.

These are some of the things in the 2018 MACRA that you'll want to know about. For more information about what the MACRA final rule entails and for assistance in remaining compliant with these new rules, be sure to contact us at ProMD today. Our practice management services can help you to remain compliant and to run your practice more effectively and more efficiently.

Outsource Your Medical Billing

Jose Carreras - Thursday, November 02, 2017

If you plan on outsourcing your medical billing, then you won't want to take the process of choosing a medical billing company to work with lightly. How fast your claims are processed and how much money you make on each claim will have a huge impact on your cash flow and net profit, which makes the selection of a medical billing services one of the most important decisions that you'll make.

The following are a few tips to help you select a high quality medical billing company:

  • Compare medical billing collection rate - You'll want to work with a medical billing service that has a high average collection rate. A high collection rate means that they most likely make few claim errors and have a good claim denial appeal process.
  • Compare medical billing process rate - Look for a fast average process rate. Medical billing services that have an average process rate of over four weeks are taking way too long. Look for an average process rate of around three weeks - this ensures that you get paid quickly.
  • Compare experience - The more experience that a medical billing company has within the industry, the more indicative it is of their quality. A company that lasts that long within the medical billing industry must be doing something right. Additionally, you should make sure that they have experience handling medical billing services that are relevant to your specific practice or clinic.
  • Compare functions - Look at the billing functions that a medical billing service can offer. At the very minimum, they should provide claim generation and submission services, carrier follow up services, payment posting and processing services, patient invoicing and support services and finally, collection agency transfer services. 
  • Ask about insurance - Ask what type of insurance each service carries. They are not only handling money, but also sensitive customer information. Ask what kind of coverage they carry, such as liability for security breaches and coverage for errors and omissions.
  • Ask about software - Ask what type of billing software they use and request details about whether it's cloud-based, whether it offers an integrated EHR, what their data backup and disaster recovery procedures are and more. 

Use these tips to select a good medical billing company. If you have questions about our medical billing services or would like more information on how we can assist your medical practice or clinic, be sure to contact us at ProMD today.

Reasons to Choose ProMD Practice Management Professional Services

Jose Carreras - Thursday, October 26, 2017

Why Choose ProMD Practice Management Professional Services to Boost Your Bottom Line

We founded ProMD with a simple premise:  Better billing leads to better care!  Your job is taking care of patients, while keeping up with the latest in medical research and best practices.  Why should you be dealing with billing concerns at the same time, when that can only distract from your core practice?  We take that burden off your shoulders, allowing you to focus your time and efforts where they matter most.

For over a dozen years, we have provided top-quality billing, collections, and professional support services to medical practices around the country.  We are aware there are plenty of other medical billing companies out there - but few can offer the same range of services, and track record of success, as ProMD.

What Sets ProMD Apart from Other Outsource Medical Billing Providers

1. A Proven Track Record
We first established ProMD in 2004 and since then, our company has only grown as we've brought more and more clients into our system.  The range of expertise we have on staff gives us more flexibility to deal with a wider variety of situations, and the result is that we consistently increase our client's collections by a minimum of 6-8%.

2. A Full Circle Approach
We aren't merely a billing outsource service.  Our "Full Circle" philosophy means we work with you directly as a consultant as well as a service.  We'll assess your practice as a whole, looking for areas which can be streamlined, and advice on implementing better procedures.  We are always available to help you implement more reliable and more efficient systems which will boost collections as well as helping to improve patient outcomes.

3. Move Towards Paperless Systems - And Save!
We can help you implement paperless systems which will qualify you for EHR Incentive Payments.  Through either MediTouch or Intergy document processing services, you can reduce or eliminate your reliance on paper while bringing faster, easier document access to your entire facility.

4. We're Only Paid When You're Paid
You don't pay us a flat rate; our fees come from a percentage of your collections. This system incentivizes us to keep finding better ways to handle your collections and processing, while ensuring you keep reaping the benefits of our services.

Increase Your Revenues with ProMD

If your practice is bogged down in paperwork and billing, ProMD will turn things around. Contact us to learn more.

When to Hire a Medical Practice Consultant

Jose Carreras - Wednesday, October 18, 2017

Sometimes, you may find yourself in a situation where you need assistance with your medical practice in terms of solving a particular business problem or figuring out a way to maximize your return on investments. However, you may not want to take on additional employees for these purposes, nor do you want to outsource any work due to the costs and lack of control involved in doing so. In such a case, you should consider hiring a medical practice consultant.

What is a Medical Practice Consultant?

A medical practice consultant is a person or company that can analyze certain problems or situations concerning your medical practice and offer up advice in the form of solutions to those problems or ideas that can benefit your business. Good medical practice consultants usually have a lot of experience working with healthcare practices and have a strong understanding of the business. The difference between hiring a medical practice consultant and outsourcing is that consultants typically are highly specialized professionals. They provide targeted and measureable results within an established period of time, which makes them a good fit for short-term and/or project specific projects (e.g. Practice and/or Billing assessments).

Determining if You Need a Medical Practice Consultant

If you find yourself needing professional advice or assistance for a short-term project, such as strategic business planning, practice assessments, practice startups, insurance contract negotiations or coding audits, to name a few, you could benefit from the use of a medical practice consultant. Not only can medical practice consultants bring their experience and expertise to the table when dealing with such situations and projects, but they bring a fresh eye as well. If you're facing a particular problem that you're having trouble solving, it's often because you're too close to the practice to be able to view the problem objectively. A medical practice consultant could identify the source of your problem immediately as well as suggest effective solutions.

Utilizing a Medical Practice Consultant

When hiring a medical practice consultant, you should resist the temptation to simply dump the problem onto the consultant's lap and let them take care of it. While this can be possible, it's a better idea to work with the consultant as a partner by collaborating with them closely. This will ensure that the work being done is consistent with what you want and what you need. Because the consultant is going to be someone that you'll work closely with and that you are going to trust an important part of your practice with, it's important that you hire a medical practice consultant that is reputable. The following are a few tips for finding a good medical practice consultant:

Find out how long they've been in the business - The longer they've worked as a medical practice consultant, the more effective they'll be. Not only is their experience a strong indicator of their quality, but it also means that they can recognize certain situations and problems and will know what solutions will work.

Find out what types of practices they tend to consult - Make sure that the experience that they have is relevant to your practice. The medical field is very broad, after all.

Determine if you get along - You'll want to work with someone you like and respect.

If you are in need of medical practice consulting services, be sure to contact us at ProMD today.

A Guide to Medical Practice Management from ProMD

Jose Carreras - Wednesday, October 11, 2017

3 Tips for Effective Medical Practice Management

By learning more on the steps your healthcare business can take to streamline its operations in the coming months, you can find new avenues for business growth. Our team at ProMD Practice Management has many years’ experience helping healthcare firms improve their operations by reducing costs and improving productivity, and in this latest post, we’ll help guide your organization forward with 3 tips for effective medical practice management.

1. Undergo a Practice Assessment

The first step in ensuring the long-term success of your organization is to undergo a structural assessment to determine where opportunities exist for improvement. It’s important that your organization undertakes a practice assessment to better evaluate its current processes and to learn where costs can be reduced throughout its infrastructure. The assessment firm will look at areas such as IT performance and billing cycles to determine how quickly bills are being paid and how effective your billing systems are at ensuring full payment in a short timeframe. This is just one area that can be improved in the assessment process.

2. Look for Billing Services

One of the most difficult challenges associated with management of a modern medical practice is having to digitize billing records for patients and ensuring that bills are paid quickly while following the latest regulations. Your medical staff have limited time to take on this process, and this means that they must turn to a specialist to ensure that billing work is completed professionally while they take on their medical work. Specialist billing service providers can also look to find ways in which to eliminate costs within the billing process and to ensure that patients pay their bills within a consolidated timeframe.

3. Follow the Latest Staffing Requirements

The needs of today’s medical services providers are continually changing. One week the company might be solely focusing on bringing in a new piece of equipment, the next they could be looking to integrate a new billing solution. It’s important that the company’s staffing matches their requirements. You should try to ensure that all staffing needs are met with precision. Look for open roles within the firm and for opportunities for expansion and then speak with local consultants about the types of staff needed to fulfill the company’s objectives in the long-term. To discover more on medical practice management strategies, contact our expert team at ProMD Practice Management directly!

Impact of ACA on Medical Billing

Jose Carreras - Wednesday, October 04, 2017

When the Affordable Care Act (ACA), which is also commonly referred to as Obamacare, was passed, it was obvious that it was going to have a big impact on all facets of the health insurance industry. A few years have since passed, and this has proven to be true - even when it comes to medical billing. So how exactly has the Affordable Care Act affected medical billing? 

How the ACA Has Affected Medical Billing

The Affordable Care Act wasn't supposed to make things like eligibility verification, pre-certification, medical billing and coding tougher on medical practices, but it did. The following are a few of the issues that have resulted from the ACA: 

More claims need to be processed - If the ACA has been successful at achieving one thing, it's to increase the number of people that have insurance. This is obviously a good thing. However, it also means that fewer people are paying for medical services out of pocket. More people have health insurance now, which means that practices need to file more claims. This, in turn, means that the billing process has become much more involved for most practices as a pure result of an increase in insured patients.

Coverage has changed - Almost all insurance plans have changed in one way or another as a result of the ACA. This means that there have been modifications in patient reimbursement rates and allowances. This has proven to be problematic in instances where the insurance companies have not communicated clearly with their customers, resulting in patients not realizing that the medical services that they've obtained may no longer have been covered or may only partially covered. This, in turn, has meant that more patients have needed to set up payment plans in order to pay off their balances.

Copays are more - Many insurance plans require larger copays or even require patients to pay a percentage of a medical service instead of a set copayment. This means that medical practices have had to get in the habit of communicating with patients before scheduled appointments to discuss or set up payment plans in order to avoid a growing outstanding balance.

Medical billing processes have gotten more complicated overall due to the ACA, which has led many medical practices to outsource their medical billing.

For information about our medical billing services, be sure to contact us at ProMD today.

A Guide to Minimizing Claim Denial

Jose Carreras - Thursday, September 28, 2017

4 Tips for Minimizing Claim Denial 

A claim denial can prolong the payment process and may even prevent your organization from achieving payment from the insurance company. One of the best ways to avoid a claim denial is to follow the guidelines offered by experts in the billing marketplace. Our team at ProMD Practice Management has decades of experience in the industry, and in this latest post we’ll highlight our four tips for minimizing claim denial.

1. Ensure Staff are Properly Trained

Your staff should be properly trained to respond to all billing demands within the office. They should know how to submit clean claims and how to follow all the latest legal guidelines while going through the claims process. For example, they should know how to select the right procedure and diagnostic code within their billing. They should also be able to verify the eligibility of patients before scheduling appointments. This can help to streamline treatment.

2. Choose Quality Claim Scrubbing Software

Claim scrubbing software can be critical to the success of a medical service provider. The claims scrubbing software helps to associate the patient with the code in the billing process. It works to identify any demographic information mistakes within the claim so that the claim can be processed normally by the insurance provider.

3. Outsource the Billing and Collections Process

Your medical team has a significant workload without having to tackle billing and collections work. They also might not have the expertise to complete billing and collections processes successfully. This might mean that your organization is missing out on billing revenue in addition to team productivity. Turning to a billing and collections specialist ensures that resources are used effectively throughout the organization. The process will help your business reduce billing errors and make sure that bills are paid promptly.

4. Have Regular Meetings on Billing Issues

You should meet with your staff on a regular basis to discuss billing issues and to determine how best to foster an understanding on billing and claims processing. Make sure that any challenges are met with a precise solution and that your billing company has an understanding on the current issues you face. Our team at ProMD Practice Management is here to guide you in reducing claim denial events. To discover more on your options, call us today!

About The Author

  

Jose Carreras, ProMDJose Carreras is Vice President and COO of ProMD. He holds a Master's Degree in Health Care Administration from Nova Southeastern University and has been in the health care industry for more than 20 years, including management positions at Jackson Memorial Hospital, PCA/CAC Medical Centers and United Healthcare. He was voted Best Practice Care Administrator by the readers of the South Florida Medical Business Journal in 2006.


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"ProMD conducted an on-site Practice Improvement Assessment of our Dermatology Practice and we were so impressed with their practice management knowledge that we engaged them to conduct twice yearly Assessment follow-up visits to monitor and ensure the findings and recommendations were being implemented. They have made a positive impact on our Practice operations"

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- South Florida Infectious Diseases and Tropical Medicine, Miami, Florida

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- Jeffrey N. Thompson, DO, Dermatology Clinics Of Westmoreland County, Murrysville, Pennsylvania