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Outsourcing makes good business sense.
Successful medical practices manage their relationship by continual face to face interactions with a competent billing service offering customizable services.
Achievable benefits with outsourced billing:
- Free up office space
- Reduce incoming phone calls
- Turn fixed expenses into variable
- Know your marketplace
- Access solid data analytics
- Know your accounts receivables
- Have a resource at payer offices
- Be prepared for a payer audit
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Value-based care comes in a variety of types, generally differing by the risks assumed by providers and sharing of savings or losses.
In the traditional fee-for-service reimbursement model, healthcare providers are paid for the amount of services performed.
Read more: How Is Value-Based Care Different From Fee-For-Service Models?
Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity.
Read more: What Is Value-Based Care, What It Means for Providers
The Health Care Transformation Task Force inched closer to its goal of having 75 percent of business under value-based payment models by the end of 2020.
The shift away from fee-for-service to value-based payment has been a slow, but steady journey.
Steps to Conducting an EHR Vendor Assessment
- Identify high-priority needs.
- Identify the most needed EHR features.
- Set specific, measurable, attainable, relevant and time bound EHR goals.
- List key decisions of potential deal-breakers.
- Decide where to store the EHR data: in-office, vendor server, or web-based.
- Narrow the field:
- Solicit the EHR experience of colleagues.
- Obtain EHR evaluaton tools and resources from medical societies.
- Utilize online information about different vendors.
- Further narrow the field using various metrics comparing vendors.
- Conduct 2-5 face-to-face vendor demonstrations.
- Compare core functionalities, look and feel, and practice management features.
- Personally preview each EHR on site, and contact references.
- Prepare lessons learned questions by your practice before, during, and after implementation.
Your patient is readmitted to the hospital with cellulitis at the incisional site during the postoperative global period after a transmetatarsal amputation.
You follow the patient for multiple daily visits. No surgery performed.
The only allowable coding option available refers to an "unrelated evaluation and management (E/M) service by the same physician or other qualified health care professional during a postoperative period."
Any diagnosis associated to the amputation will not qualify, only an "unrelated" one will.
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Choosing the right Electronic Health Records (EHR) for your practice can be a daunting task.
There is enough research documenting improved productivity levels and efficiency gained by EHR Software implementation.
Large physician practices may have financial flexibility to implement an EHR with bells and whistles driving up the price point.
Small practices often lack this luxury.
Specific critical technological features exist to assure the overall practice success when choosing the right EHR.
Diagnosis codes must be reported based on the date of service (including, when applicable, the date of discharge) on the claim and not the date the claim is prepared or received.
When desiring to indicate a distinct procedural service the physician may need to indicate a procedure or service was distinct or independent from other services performed on the same day.
This may represent a different session or patient encounter, different procedure or surgery, different site, or organ system, separate incision/excision, or separate injury (or area of injury in extensive injuries).
Ophthalmology Surgical Modifiers
- Extracapsular cataract removal with insertion of intraocular lens prosthesis
- Extracapsular cataract removal with insertion of intraocular lens prosthesis
- Right and Left done on same day Number of units 1
- Multiple surgical procedures
- Performed at same session, by same physician on same day
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Because demands for coders is high, wages continue to increase with the average salary in Illinois reaching $50, 394 as of September 28, 2018.
Here are salary statistics for a medical coder and biller in Illinois:
- Top Earned $60,919
- Median Wage $54,880
- Lowest Earned $43,711
Surgical Modifiers
- Bilateral
- Multiple
- Reduced
- Discounted
- Co Surgery
- Team Surgery
- Assistant Surgery
- Bilateral Surgery
- Performed on both sides of body at the same operative session to the same organ or structure
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