AMAPrescription for a healthier practice: Hold health insurers accountable for out-of-network services
For this month’s practice checkup, ensure that your practice receives payment for out-of-network services it provides. Start with, “Holding health insurers accountable for out-of-network services.”
Prescription for a healthier practice: Increase your practice’s efficiency
Prescription for a healthier practice: Know the cost of doing business with your payers
Prescription for a healthier practice: Learn about vendors offering e-billing solutions
The AMA provides a listing of e-billing vendors physicians may consider using, particularly for workers’ compensation and auto claims, to streamline the process and help you get paid more quickly and with fewer denials. Access the AMA’s workers’ compensation e-billing vendor listing to learn about some of the many practice management system vendors and clearinghouse vendors offering these solutions.
Prescription for a healthier practice: Move toward real-time adjudication
Prescription for a healthier practice: Prepare for health insurer retrospective audits
The AMA and the American Academy of Neurology present this AMA-members-only resource "How to prepare for a health insurer retrospective audit" to educate physicians and their staff about the recoupment efforts of health insurers through the retrospective audit process. They encourage physician practices to use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit's findings.
Prescription for a healthier practice: Receive out-of-network payments for services you provide
It can be challenging to receive fair payments for services provided to patients who have health insurance from a payer with which a physician practice has not contracted. The AMA provides resources to equip physician practices with the knowledge and tools needed to navigate these challenges and ensure fair payment is received. Go to the Out of Networks Payments page of AMA’s website and view a variety of practice management resources on this issue.
Prescription for a healthier practice: Reduce claim denials
Prescription for a healthier practice: Select a practice management system to maximize efficiency
Prescription for a healthier practice: Simplify the claim audit and appeals process
This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.
Prescription for a healthier practice: Streamline your overpayment recovery processes
Streamline your overpayment recovery process by reducing manual workflows and creating efficiencies in your claims revenue cycle. Click here to access “Questions to consider when addressing payer overpayment recovery requests on individual claims.”
Prescription for a healthier practice: Switch to e-billing and improve key practice metrics
The AMA recommends that physicians switch from paper billing to e-billing, particularly for workers’ compensation and auto injury claims. AMA says e-billing can help improve the rate of first-time acceptance and your revenue cycle, and reduce the rate of resubmissions and the number of payer status calls. To get started in automating these claims, watch “Workers’ compensation e-billing - A rapidly evolving solution to a historic revenue cycle headache!” which walks you through the process of adopting e-billing.
Prescription for a healthier practice: Understand your contracts
Don't let contracts with managed care organizations intimidate you; gain a better understanding of what they say. AMA encourages physicians to learn more about how a negotiated fee schedule can affect your practice's bottom line by reading "Obtaining, uploading and utilizing your contracted fee schedules," also available on the AMA's Defensible Fee Schedule Toolkit webpage. The step-by-step guide will help you easily and accurately load contracted fee schedules into your practice management system.
Red Flags Rule: AMA Sample Policy
Red Flags Rule: What You Need to Know