Question

A multiple EOB/RA comes back to a large group practice filled with details of the status of claims including a voucher (check), suspended claims, denials, and rejections for various patients and physicians. What are some steps the medical office administrator can take to record the completed transactions and address any outstanding problems? Describe the accounts receivable administrative functions in general- what kinds of procedures need to be incorporated into the practice's business methods and manuals? Lucy, a 22-year-old, just entered the workforce and must choose a health care plan offered through her new company. She says she is daunted not only by the variety of managed care plan options, but by all the acronyms associated with those options. She asks you what the main differences are among IPAS, PPOs, and POSS. What are some of the pros and cons for a physician becoming a participating physician (par) in Medicare?

The question is all about the insurance handbook for medical office

Answer 1

1.Always date and sign your notes, whether written or on computer. Don’t change them. If you realise later that they are factually inaccurate, add an amendment.

2.Any correction must be clearly shown as an alteration, complete with the date the amendment was made, and your name.

3.Making good notes should become routine.

4.Document all decisions made, any discussions, information given, relevant history, clinical findings, patient progress, investigations, results, consent and referrals.

5.Medical records can contain a wide range of material, such as handwritten notes, computerised records, correspondence between health professionals, lab reports, imaging records, photographs, video and other recordings and printouts from monitoring equipment.

6.Do not write offensive or gratuitous comments – eg, racist, sexist or ageist remarks. Only include things that are relevant to the health record.

7 Remember patients have a right to access their own medical records under Promotion of Access to Information Act (PAIA), No 2 of 2000.

8.Risks can never be eradicated, even with best practice, only reduced. Good record-keeping helps to maintain best practice, aiding clear communication between professionals, and demonstrates that best practice has been followed.

9.Complete, contemporaneous and well-organised medical records are essential for good medical practice and continuity of care. They are necessary for a healthcare professional’s defence against a claim or complaint and can be seen to reflect the quality of care provided.

10.Appropriate record-keeping is recognised as an important component of professional standards

Procedures

1.Articulation Of Required Steps: A procedure lays out the required steps to perform job tasks or provide a service to a customer.

2.Performance Measures: Procedures can also be used as a tool to measure an employee’s performance by determining if the process was followed appropriately.

3.Process Consistency: When procedures are followed, there is consistency in practice for work processes.This consistency helps to ensure that things are done the same way, every time, and that all of the procedural steps are followed.

4.Incorporates Worker Experience: Policies and procedures are created from the experience of those who perform job tasks and records the work methods of experienced employees.

5.Training Refresher: Having a written policy and procedure manual can be used as a tool to help train employees and serves as a reminder of procedure steps and expectations.

Prons and cons for a physician becoming a participating physician in medicare

Prons - Faster Payments and Less Hassle with Medicare

“The truth is that Medicare doesn’t pay the best, but the hassle factor is the least, and it pays the fastest,” says Cohen. “Medicare is also totally transparent with its fee schedule, so you can plan ahead.”

Prons - Build Patient Volume

Accepting Medicare patients essentially allows physicians to grow their patient volume while establishing a predictable cashflow. “Practices can build volume on the front-end because there’s no shortage of Medicare patients out there,” he adds.

This is especially true for new practices. A recent study by the Kaiser Family Foundation found that younger physicians are more likely to accept new Medicare patients as they build their patient caseloads.

Prons - Lower Denial Rates

Even though Medicare often pays less than commercial payers, Cohen says the denial rate is also often much lower, meaning physicians recoup much of what they bill without needing to waste precious time and administrative resources on appeals and resubmissions.

With private payers, reimbursement amounts may be higher, but denials occur much more frequently. “You’ve got to fight them to get your money. Sometimes it’s just not worth it,” he adds. This game of ‘bait and switch’ makes it difficult for practices to grow. The turnaround time for payments also tends to be longer with private payers, making cashflow problematic—particularly when a practice is trying to expand, he adds.

Con - Lower Reimbursement

Still, there are cons to participating with Medicare. Reimbursement amounts are one of the biggest cons with Medicare paying an average of 20% less than most private payers, says Cohen.