The purpose of this group being formed within HSMN is to help both Physicians and Hospital Organizations/Systems decide whether such a step is feasible financially and what next steps must be taken. Many of our Physician and Hospital clients are asking for help as they respectively decide to join an ACO or create one by… Continue Reading
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Ambulatory Care Hospital Billing, APCs and Technical Hospital Billing
For 27 years Health Systems Management Network, Inc. has worked with various Hospitals, Health Systems and Physician clients to help them optimize their ambulatory care and practice billing. When the Ambulatory Payment Classification (APC) system became the payment methodology, HSMN was among the first firms working to prepare all of its clients to be successful… Continue Reading
Denial Management with Root Cause Analysis
The structure of the healthcare financial management organizations which often have silos where they should have integrated contiguity often precludes the ability to analyze the root cause of claim denial. Without understanding the cause and the source, claim denials keep mounting and the effort to resubmit claims becomes such a labor intensive project that many… Continue Reading
A Little More on the Physician Value Based Modifier
News Update: On August 1, 2012 CMS held a national provider call designed to help health care professionals understand how they plan to implement its new value-based payment modifier initiative! This will become a reality for physicians starting in 2013. Those provider groups with 25 or more eligible professionals will see a -1.0% downward adjustment… Continue Reading
Healthcare Payment Methodologies
HSMN Healthcare Payment Methodologies Continue Reading
Provider-Based, to be or not to be?
Congress has been advised to “direct the Secretary of Health and Human Services to reduce payment rates for evaluation and management office visits provided in hospital outpatient departments so that total payment rates for these visits are the same whether the service is provided in an outpatient department or a physician office.” This recommendation was… Continue Reading
Changes are coming, are you ready?
The “Physician Value-Based payment modifier” will start in 2015. Payment will be based on 2013 data. This program will become a reality for Physicians in January of 2013. Wait we know what you are thinking! This is part of Affordable Care Act and that may not pass! Well hold on to your hats – this… Continue Reading