Many large groups, IPAs, and ACOs are considering taking control of the credentialing process by replacing the traditional provider enrollment (credentialing) model with delegated credentialing—earning the formal approval of payors to credential their own providers. Becoming delegated can mean decreased denials and quicker, more predictable cash flow. But preparing for delegation requires careful planning and thoughtful execution.

Managing your practice’s revenue cycle can be one of the most time-consuming and complex parts of running your business. If you are spending more time managing revenue then you are managing your patient’s health, it’s time to engage with a revenue cycle management (RCM) company. The key is finding the right revenue cycle management company for your specific needs. In this blog post, we will focus on the key questions you should ask potential RCM partners to determine the best fit for your practice.

Declining reimbursement, the increasing costs of operating a practice, time-consuming regulatory burdens, and hassles with getting paid by insurance companies and patients are putting enormous pressure on your practice's revenue cycle. Collecting every dollar and driving your revenue growth is critical to success. Any easy place to start is by maintaining a full and productive schedule. 

CMS announced last Friday an extension to the deadline for hardship exemptions from the Medicare EHR Incentive Program's meaningful-use requirements. The new deadline is July 1 adding several months from the former deadline of March 15 for eligible professionals, and April 1 for eligible hospitals and CAHs.

Historically, the purchasing and financial decisions for healthcare services were made at the “wholesale” level with arrangements between the payers, providers, and the employer; with the patient glaringly absent. With the introduction, and subsequent mass adoption, of High Deductible Health Plans (HDHP) the patient now has “skin in the game” assuming more of the financial responsibility for their healthcare needs.

In an earlier post, we reviewed the 5 things you need to know about the Merit-based Incentive Payment System (MIPS). The MACRA bill that introduced the MIPS program also provides incentives for participation in Alternative Payment Models (APM) in general and bonus payments to those in the most highly advance APMs. We detail the particulars of these incentives in this blog post.

It’s a new year, which means it’s time for a new deductible season. January is the time most insurance companies restart the calculation of annual deductibles for their members. This resetting of annual deductibles means a significant increase in patient responsibility for many practices. To ensure you are collecting on these patient owed balances, practices will need to employ every effort they can to get paid upfront. Are you ready for the challenge? 

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. The legislation’s purpose was two-fold. It repealed the sustainable growth rate (SGR) and introduced a new quality reporting program called the Merit-Based Incentive Payments System (MIPS).

As we enter into 2016, MIPS will take on more importance as some of the requirements of the program start to take shape. Here are the five key things you need to know about MIPS.

In an effort to ensure that consumers are able to rightfully access their health information, the Health and Human Services Department released new guidance on the HIPAA Privacy Rule. The guidance covers information such as patients' general rights to their protected health information, what data is excluded from that right to access, how an individual may request access and how an entity must provide the information, among other topics.

Meaningful Use Stage 3

Health systems across the U.S. are urging the Department of Health and Human Services (HHS) to delay implementing Meaningful Use Stage 3. In a letter sent to HHS Secretary Sylvia Burwell, these organizations expressed concerns that the release of Stage 3 will hinder much needed efforts to improve technology to achieve interoperability.