Take these steps now to ensure optimal performance in 2020:
Each year it is important to review best practices for optimal Outpatient Endovascular & Interventional Center performance and to ensure that these are integrated into your daily, weekly, monthly and quarterly plans. As the industry becomes more competitive and reimbursement rates continue to decline, you must be ever vigilant to ensure optimal performance. Here are the top 10 things you should be doing:
- Billing Goals – Meet with your billing team/company to review 2019 performance and set goals for 2020.
- Payer Contracts – Review your major payor contracts to see if and how your allowed amount fee schedule may change in the upcoming year
- Compliance Plan – Review Compliance Plans (HIPAA and OIG) and ensure your staff receive training at least annually
- Physician Documentation – Review physician documentation standards to for completeness and accuracy to meet today’s standards
- 2020 CPT Codes – Review 2020 CPT book for your frequently performed cases to understand the language that coders and payers will be looking for.
- MIPS – Check your QPP Participation Status at (https://qpp.cms.gov/participation-lookup). If you are eligible to participate, pick your MIPS registry and identify which quality measures you plan to follow this year.
- Patient Registration – Office practices – review your front desk scheduling, patient registration, insurance verification, and time of service payment policies and procedures to ensure you capture accurate patient information and collect as much as possible from the patient at the time of service.
- Note: StreamlineMD clients can use our new Patient Payment Estimator which uses AI to predict the amount the patient will owe based on how your practice has been paid for the specific procedure by the patient’s insurance company.
- Visit-to-Claim Reconciliation – Review your process of reconciling patient scheduling, documentation, coding and charge capture workflow to ensure no claims are left behind. Hospital practices, confirm that your hospital is transmitting not just reports and patient demographics electronically, but also department logs. This is important to complete a full patient reconciliation to ensure no claims fall through the cracks.
- Note: StreamlineMD’s Premier and Complete clients have this feature integrated into their workflow already.
- Denial Review – Review your previous year’s most frequent claim denial reasons and take steps to eliminate them. Office practices, ensure that referring physicians provide timely and complete prior authorization and reason for the visit. Hospital practices – Meet with your hospital representative to review denials that stem hospital processes such as lack of prior authorization, medical necessity due to missing signs/symptoms on orders, or invalid insurance.
- Note: StreamlineMD’s Premier and Complete clients have the benefit of our Prior Authorization Tracking tool to keep your requests organized, your follow up simple, and to prevent unnecessary denials. Please see the following links to previous blogs on Preventing Prior Auth Denials:
- Patient Refunds – Review your patient refund policy and confirm that you have submitted your unclaimed funds report to your state, if applicable.
Taking these steps in the first couple weeks of each year will ensure that you get off to a good start and optimize your overall practice performance for the coming year. If you have any questions, please contact your StreamlineMD client rep or sales at 330-564-2639.