Practice Evolution
Through the Practice Evolution education series, the Colorado Medical Society strives to help physicians better understand the interconnection of major issues in health care and better thrive in delivery system models. The four Practice Evolution categories are payment reform, practice redesign, transparency and administrative simplification.
Prescription for a healthier practice: Fight for accurate payment by decoding payer ERAs
The AMA has developed a tool to help address the hassle of decoding electronic remittance advices (ERAs) to determine if a billed claim was properly paid. If your practice performs property and casualty (workers’ compensation and auto injury) e-billing and receives ERAs, the AMA’s Claims Workflow Assistant tool can help you understand and address payment adjustments from payers. You can look up the reason or remark codes that payers place on the ERA to find associated workflows that can assist you in addressing claim denials or non-payments. And, you can look up the reason and remark codes payers place on the remittance advice to explain how the claim was processed and determine what those codes mean. Then, you can follow the steps provided to ensure accurate payment. The Claims Workflow Assistant also provides template appeal letters that physicians can easily modify to use in their practices.
Prescription 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: 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: Protect your practice from inappropriate discounts
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: 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.
Webinar: 2013 Medicare incentive programs
This one-hour webinar from the Centers for Medicare and Medicaid Services provides an excellent, easy to understand overview of the Physician Quality Reporting System (PQRS), e-prescribing (eRx), and the Electronic Health Records (EHR) meaningful use incentive program. Learn how decisions to participate in one or more programs could affect incentive payments or payment adjustments to Medicare reimbursement. Topics covered include: eligibility, important 2013 deadlines, and decision trees for each program.