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Medical Practice Management & Consulting
NewsWire                                                                                         October 2010
In This Issue
OIG Increases Auditing Efforts
8 Ways to Maximize Collections
OIG Increases Auditing Efforts

In September 2010, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services published its 2011 Work Plan, which became effective on Oct. 1, 2010. The Work Plan describes the areas in which the OIG will focus specific audit, investigation, enforcement and compliance activities.


The OIG indicated that it will review the extent of potentially inappropriate payments for evaluation and management (E&M) services. CMS's Medicare Claims Processing Manual instructs providers to "select the code for the service based upon the content of the service" and says that "documentation should support the level of service reported." Medicare contractors have noted an increased frequency of medical records with identical documentation across services.


You can incorporate the following steps in your practice to prepare for the OIG's increased auditing efforts:

  • Analyze the individual coding and billing practices of the physicians in your practice
  • Compare them with national averages by specialty 

This analysis can then help you identify and rectify any billing or coding practices or patterns that might draw the attention of the OIG or other governmental agencies.


Visit the OIG Web site to access its Work Plan.

"If you can't measure it, you can't manage it."

                  Author Unknown
Governor Schwarzenegger signs the bugdet


California enacted two bills last week that will establish the California Health Benefit Exchange. The bills are California Assembly Bill 1602 and Senate Bill 900,

968,765 workers will lose out on the promise of better health coverage 

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8 Ways to Maximize Collections

Efficient billing and collections processes are critical components of a successful and profitable Checklistmedical practice.  Most practices leave between 5% - 30% of their reimbursement on the table because they lack proper processes, staffing, training or technology.  Industry experts say the first 80% of payments are relatively easy to collect.  It is the remaining 20% that are harder to obtain and more expensive to collect. Follow the following recommendations and regain control of your billing operations:


1. Verification of benefits and patient registration

It is increasingly important to verify a patient's benefits prior to the date of service.  It can decrease the cost of collections, minimize the risk of writing off a balance and significantly improve your cash flow.  This is also an opportunity to address outstanding balances and copays. 


2. Medical coding

Providers of service are the most certified to code for their services.  This will ensure that the coding is proper, the first time.  Missed or improper codes can equate to thousands of unbilled dollars and expose the provider to potential liability and compliance issue.  Auditing consultants or firms, hired annually, can help ensure accurate and complete claims and coding functions. 


3. Charge validation

Prior to submission, claims should be scrubbed by an industry-specific tool that uses standard and custom edits.  The system should automatically detect coding combinations related to unbundling, modifier appropriateness and mutually exclusive procedures.   


4. Remittance management and payment posting

Automating the process of retrieving and posting payments reduces human error and cost.  Electronic funds transfer also puts the money in your bank account quicker.


5. Denials management

This is one of the most neglected areas due to the labor involved and intrinsic knowledge needed. A dedicated team with the experience of multiple payor reimbursement policies should be involved to address this issue.


6. Insurance follow-up

Timely and effective follow-up specialists can use variety of tools to achieve results in the shortest amount of time. 


7. Reporting capabilities

Regular reports should be customized to provide specific metrics that yield a comprehensive view of the practice's financial performance, as well as insight for making smart business decisions. 


8. Technology

To assist your team of knowledgeable experts, investing in state-of-the art technology could save you a lot of money in the long run.  Consider using a technology for your billing platform, claims scrubber software, document imaging system, electronic remittance for posting and the ability to submit claims electronically.  


The business of healthcare has changed over the years and understanding the nuances and knowing how they affect your bottom-line are the foundation of effective financial management. 


Source: MGMA


If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.
Med-Pro Management, Inc.

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