HSMN has learned that MEDPAC (The Medicare Payment Advisory Commission) is set to reduce Hospital payments for Ambulatory/Outpatient procedures to the rates paid in a Physicians’ office. Their reasoning is clear: why should the “people’s money” (taxes) be used to pay higher rates in Hospitals for the same service patients can receive in a Physician’s office? There are many procedures (66 to be approximate) that will be affected.
Health Systems Management Network, Inc. after 27 years of working with Charge Capture, Hospital and Outpatient Billing throughout the country has an answer. Get ready because it will happen! The various Hospital Associations are lobbying to prevent such cuts but MEDPAC will present its recommendation and call it “Budget Neutral” which means a loss of $275 million dollars to hospitals across the country.
There is only one answer: be prepared by doing a review of the total billing operation for Outpatient billing procedures in your organization. A detailed review beginning with the “Orders”, authorizations, actual procedures performed and final claim preparation must be carefully reviewed by looking at each function including how “Orders are placed”. In HSMN’s experience most Outpatient settings are losing up to 20% of their revenue because of faulty authorizations and denials based on clinical documentation.
HSMN has developed a seasoned and professional team to review roles, functions, work processes and organizational structure with a view toward strengthening and adjusting the entire billing cycle so that it can reduce denials by improving every aspect of the Cycle. For 27 years HSMN has reviewed and implemented processes, roles, structure and metrics to improve the Revenue Stream for Outpatient procedures. This is the only answer to cuts that will not be called cuts. They will be referred to as “Leveling the playing field”. Now is the time to do a comprehensive review and put into place a program to increase revenue through smart work flows and tweaking whatever Systems in use to flag errors that are both human and Systems caused and correct them before they get to final claims.
Many hospitals tell HSMN that their organization is covered by new Systems. HSMN’s experience is that nothing goes into those Systems that doesn’t have a human source such as the Medical staff, registrar, scheduler, coder, and biller. Therefore, Systems don’t solve the problem; they are often part of the problem and solution.
HSMN has found among its clients that improvements of 1-6% will more than make up for any reductions in reimbursement that are put into place. Now is the time to take the decision to and proactively tune up and restructure Hospital Outpatient Billing.
Call us 866-908-4226 or email firstname.lastname@example.org for a consultation and discussion.