The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

Sample Medicare Card with Medicare Beneficiary Identifier

The Medicare Access and CHIP Reauthorization Act of 2015, commonly known as MACRA is bringing dramatic changes for Medicare beneficiaries and the providers that serve them. MACRA is bringing big changes for anesthesiologists and CRNA’s.

Could these changes result in rejected claims and unpaid charges? The answer is YES!

We are watching this transition closely and managing the transition process for our anesthesia providers. Since we have spent so much time working on MACRA, we thought that we would share the Top 5 Things that anesthesia providers need to know about how this will affect their practice.

The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

#1: MACRA requires removal Social Security Numbers (SSNs) from all Medicare cards by April 2019.

Health Insurance Claim Number (HICN) identifiers have come under increasing scrutiny because the prominent use of Social Security Numbers creates a significant risk for beneficiary identity theft. All beneficiaries will receive a new Medicare card by April of 2019.

#2: All beneficiaries will receive a new Medicare Beneficiary Identifier (MBI).

The new Medicare cards will replace the HICN with a Medicare Beneficiary Identifier (MBI) that doesn’t incorporate the SSN. MBI’s use the same number of digits as the HICN, and it will occupy the same fields. The MBI was designed to avoid commonly mistaken letters and numbers like “0” and “O”, and it is not based on the SSN in any way. This MBI is unique to each beneficiary.

#3: Transition period begins April 2018 through December 31, 2019.

Both numbers will work during that time. Starting on January 1, 2020, HICNs will no longer be exchanged with beneficiaries, providers, plans, and other 3rd parties. The HICN will only be used for appeal requests and related forms that were accepted using an HICN.

#4: This change will lead to complex system changes.

MACRA requires complex system changes affecting the federal government, state governments, beneficiaries, providers, and plans. These groups are spending countless millions of dollars implementing system changes that may directly affect your Medicare claim filing process.

#5: Failure to comply with MACRA will prevent you from getting paid!

Starting on January 1, 2020, your claims will not be paid unless they are filed appropriately using the new MBI. Any claim submitted with the HICN will not be processed, resulting in significant delays in getting paid.

Anesthesia Providers and MACRA

Medical Business Management works with CRNA’s and Anesthesiologists to ensure that their claims are submitted accurately and paid in a timely manner. We navigate the complicated transition process and manage your revenue cycle so that you can focus on what you do best: serve your patients.

If you would you like to find out more about MACRA; Contact us today about how these changes will impact your revenue cycle.

Here Is a Five-Step Process for Better Cash Reconciliation

revenue cycle management

All medical practices have issues with managing patient accounts receivables (AR) and cash reconciliation. It’s not endemic to just one specialty. And while some practices are better at revenue cycle management than others, all run into problems eventually.

Earlier this month, we talked about creating a better reconciliation process. In this post, we’ll give you a five-step process to improve cash reconciliation with your AR, which can better track the comings and goings of patient payments and ensure everything adds up at the end of the day.

Step 1: Cross-Check and Verify

By the end of each day, you should have a total of all transactions made that day. This includes all cash payments, all insurer payments, and anything that was filed that day on behalf of a patient. Then, calculate the total billing that was done for each patient that day. These two numbers, at the end of the day, should match.

If this sounds tedious, that’s because it can be — if you do it by hand. There is software out there that can do it for you, but you still have to cross-check the totals and verify that everything adds up.

Step 2: Calculate Daily Billing

Daily billing includes the total of all cash, checks, and credit card payments made by patients for their visit – including deductibles, co-pays, and fees. This number should be added to the actual payments that the practice received that day.

This grand daily billing total should equal the previous calculations we talked about in step one. If there are discrepancies, it’s necessary to go back to step one and re-evaluate all payments for that day. Again, software can automate this process to a degree.

Step 3: Reconcile Rejected Claims

Not accounting for rejected claims can throw your reconciliation process out of order. You need to know when claims are rejected and for what reason. Don’t factor in anything that was rejected. If you do, you’ll have imbalances and an inaccurate figure. (Plus, from a practical standpoint, you’re less likely to go back and resubmit the rejected claims, which deprives your practice of revenue).

Step 4: Only Post Clear Payments

Payers will usually send you a confirmation per batch of paid claims before the money for those claims is deposited into the practice’s account. However, before you can record this as payments received, the payments must clear the bank. Don’t assume the money will go through just because you received a confirmation. There are plenty of reasons for a problem or a delay.

Step 5: Track All Reimbursements

Tracking reimbursements can be difficult, but it’s essential. When you have a patient encounter, that patient encounter will generate a certain number of reimbursement elements. These reimbursement elements could involve write-offs, or could be required to be resubmitted to the clearinghouse in the form of secondary/tertiary claims.

Tracking reimbursements includes several key tasks, such as making changes to any previously determined co-pays and deductibles, making manual adjustments to send patients correct bills (especially if co-pays or deductibles changed), adjusting for write-offs, and preparing secondary/tertiary claims.

Hiring a Revenue Cycle Management Provider

This may sound very complicated, and to a large extent, it is. That’s why hiring a third-party revenue cycle management provider is a good idea. Doing so frees up valuable time and resources that can best be used elsewhere, such as delivering better care for patients. And, a practice doesn’t have to spend time and money finding and training personnel who have the skills necessary to handle something as complex as cash reconciliation.

If you can reconcile your cash payments with AR in a fluid, effective manner, you’ll maintain a steady stream of revenue without losing out on payments that should have been made. A third-party provider can help make this a reality for your practice.

Keeping in Tune with Your Anesthesia Practice

anesthesia revenue cycle management

Do you know how well your anesthesia practice is performing?

Providers think they know the answer to this question, but when they really drill down to figure out exactly how well their practices are performing, they often find themselves struggling to come up with an answer.

After all, there is a sliding scale of “well.” A practice may appear to be doing “well,” but what, exactly, does that mean? Are key performance indicators (KPIs) up or down? Is the practice more efficient – or has it become stagnant? Are there areas for improvement, and are there plans in place to improve these areas?

To get the most out of an anesthesia practice, a provider has to keep in tune with every aspect of the business and stay abreast of what’s happening and why it’s happening – and how it can be made better.

Using Technology to Stay Informed

Knowledge is power, or so they say, and the same goes for running a practice.

Technology can provide more information for you than ever before, giving you all the data and knowledge you need to run your practice with efficiency and effectiveness.

For example, technology can help you:

  • Analyze your revenue cycle
  • Keep track of your billings and identify fluctuations
  • Access reporting
  • Keep up with any task for any part of your practice
  • Know what is working and what isn’t

Using technology is a must, not just for moving to a paperless office, either, but for truly understanding what is working well and what needs to be improved (as well as making your office more efficient all around).

Following Key Performance Indicators

KPIs set standards for you to follow so that your practice has steady benchmarks of progress – allowing you to see, at a glance, if you’re meeting your goals.

Examples of KPIs and standards include:

  • Total unpaid claims (shoot for under five percent)
  • Number of days from time of service to submitting a claim (the industry average is three days)
  • The percentage of claims paid in 45 days or less (try for no less than 85 percent)
  • Denial rate (shoot for under five percent)
  • Net collection rate (the industry standard is 95 percent or above)
  • The percentage of accounts receivable that are over 120 days past due (should be no more than 15 percent)

Following these KPIs can tell you very easily if you are ahead of the curve or lagging behind. Once you are aware, you can take steps to rectify these problems and improve your numbers.

Anesthesia revenue cycle management can accomplish all of these things, from providing technology to manage your practice to identifying, following, and improving KPIs. Contact a third-party revenue specialist to learn more about outsourcing this crucial part of your practice and improving your results.

6 Things to Know About Hospital Revenue Cycle Management Solutions

hospital revenue cycle management

Revenue cycle management has always been important for hospitals, but the importance of RCM is even more apparent in today’s competitive – and growing – healthcare environment, especially as consumers start to take on more of the burden of paying for care.

There are growing financial pressures on providers that require a shift in provider and hospital revenue cycle management solutions. In order to successfully make this shift toward more accountable and effective RCM, hospitals need to understand the current and future landscape of revenue management in the medical field.

Here are six things to know about hospital revenue cycle management solutions in 2016 and beyond.

Hospitals Care About Reimbursement

According to a poll from Cardinal Health, reimbursement is the primary concern for hospitals and other providers in the market today. (The second leading concern was high cost of supplies.) Reimbursements are a primary driver of revenue for hospitals, so managing them effectively and ensuring steady cash flow in a timely way is of paramount importance.

Collections Cost More

Hospitals and other providers are finding that the cost of collecting payments has gone up over the years. From 2011 to 2013, the cost of collection went up from 1.9 percent to 2.6 percent for hospitals with the highest RCM performance – and from 2.8 percent to 4.2 percent for hospitals with the lowest performance.

To deal with rising costs of collecting payments, many hospitals are outsourcing their collection services and shifting those burdens away from in-house staff that require higher overhead. Outsourced collection services can reduce the overall cost and ultimately save money.

Hospitals Frequently Underreport Medical Conditions

One problem hospitals face with RCM is underreporting medical condition. A study from Johns Hopkins University School of Medicine determined that underreporting common medical conditions – and under-coding them – can have a disastrous effect on the financial health of hospitals, not to mention their reimbursement rates. These conditions include tobacco use, alcohol use, and obesity in particular.

More Price Transparency Required

In today’s consumer-driven healthcare market, providers are learning that patients – and the government – are moving toward more price transparency in billing. Lawmakers across the country have introduced or advanced measures to eliminate surprise medical bills and increase price transparency in billing. It will not be long before hospitals have to take a serious look at price transparency within its billing and RCM systems.

It May Make Sense to Wait on Billing

A common practice is to bill the patient immediately following the delivery of services. This can overwhelm the patient, though, resulting in delayed and lagging reimbursements because patients frequently do not understand when to pay their bills, or even what to pay. Waiting until the patient’s deductible is met may be a more prudent and overall effective option that can increase reimbursement rates.

Outsourcing Hospital Revenue Cycle Management Solutions May be Best

When polled, 72 percent of hospital CFOs across the country considered outsourced comprehensive hospital revenue cycle management solutions to be the best option right now for their systems. Outsourcing has several key benefits, namely lower overhead and costs and a more efficient, streamlined process that can increase collections and reimbursements.

For more information about outsourcing RCM, contact Medical Billing Management.

The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

The Medicare Access and CHIP Reauthorization Act of 2015, commonly known as MACRA is bringing dramatic changes for Medicare beneficiaries and the providers that serve them. MACRA is bringing big changes for anesthesiologists and CRNA’s. Could these changes result in rejected claims and unpaid charges? The answer is YES! We are watching this transition closely […]

Here Is a Five-Step Process for Better Cash Reconciliation

All medical practices have issues with managing patient accounts receivables (AR) and cash reconciliation. It’s not endemic to just one specialty. And while some practices are better at revenue cycle management than others, all run into problems eventually. Earlier this month, we talked about creating a better reconciliation process. In this post, we’ll give you […]