Aftercare from ER/Observation

August 4, 2016

We need to do more upon discharge of the elderly back to their home environment. When there are return trips to ER this should be triggering the lack of support in the home.  Also Observations get over used due to the fear of non-payment by Medicare but to the neglect of what a patient truly needs.  Perhaps a change in the SNF reg’s need to be looked at;  also the Acute Rehab & the SNF Rehab.  It is much more costly to decrease Home Care Services that only result in higher costs and/or death.  If group homes with home care covered services were available it would be ideal (a type of assisted living combined with independent living). This definitely would support the patients emotional & spiritual needs.  Let’s change how we do business & cutting costs means keeping patients healthy & independent.



September 12, 2015

I do find the above  blog very good & applaud the openness in discussing grief.  It is definitely a process & an individual journey.  I have experienced sudden loss of several close, intimate & family members as well as a prolonged death of both parents.  Each grief process was different & I believe for me it had to do with grieving along the way vs having no prep time.  One thing that was the same for both was holding on to the good memories & reflecting on them during sad times & filling up with gratitude for what we had an opportunity to share.  My reality has been that we never know when death is to appear & we do our best to enjoy when we are alive.

Revenue Cycle Quality Improvement So important to identify all the steps in the Revenue Cycle & to eliminate repetitive steps & unnecessary ones. Will improve flow at a lower cost.  All staff from registration through collection have to be on the same page & know the importance of accuracy.Ownership of each part of the process will improve quality.  Training & Cross Training needs priority to improve cash flow.  The fewer times a claim needs to be addressed, cash flow and the cost of such will improve.Always learn from the denials & the best way to identify training & process improvements.

May 23, 2015

Staff Recruitment & Training in Billing & Followup

May 23, 2015

Finding experienced billers for a specific type of billing is not all that necessary. I have had great success in my 30+years of Revenue Cycle Management of training experienced billers with one type of service to another.  Billing regs are basically the same but product billing will vary; auth’s, coding etc.  this is built into a system that is easily learned & training is what is important.

Finding potential staff that are willing to learn; know the importance of timeliness & accuracy; has the ability to communicate, ask questions & read billing manuals & regs; as well as has the motivation to do timely followup & challenge incorrectly denied claims is very important & significant.

MMCS has the experience and ability to set up training schedules & assist in improving staff structure.

Most important not to delegate the responsibility of Revenue billing & followup to an outside source.  Take responsibility to keep this important function close to “home”!

New trend in Healthcare Billing

May 22, 2015

Many Providers are turning their billing over to their Computer Co’s.  Delegating the responsibility to others doesn’t eliminate Payor responsibilities & must be monitored closely. My experience has been that there has been disasters with this type of arrangement.  

If Providers are having difficulty recruiting experienced help, it is important to look at training and a tier structure for responsibility & pay scale in the billing/AR office.   There are now Payor websites which have great training tools as well as webinars.  

It is always best not to outsource billing but look at how you can supplement the FTE’s & set up a training schedule.  Training is always ongoing.  

Outsourcing uses inexperience staff as well as experienced & as it is not their Payor contracts they have less on the line.

Overcoming Medicare Overpayments With Extended Repayment Schedules

October 10, 2013

Very clear & concise the obligations of the provider re: repayments of overpayments or audit findings. More important to identify process improvements to eliminate overpayments & audit recoveries.

Effective September 3, 2013, the Centers for Medicare and Medicaid Services (CMS) revised provisions of the Medicare Financial Management Manual that relate to provider requests for Extended Repayment Schedules (ERS) in connection with Medicare overpayments, including overpayments identified by Recovery Audit Contractors (RACs).

In general, if a Medicare Administrative Contractor or provider determines that an overpayment exists, the provider is required to repay that overpayment within 30 days.

Chapter 4 of the Medicare Financial Management Manual provides a process for a provider to request an ERS (formerly known as an Extended Repayment Plan), if repayment within 30 days would constitute a “hardship.” A hardship is defined to exist “when the total amount of all outstanding overpayments (principal and interest) not included in an approved, existing repayment schedule is ten percent or greater than the total Medicare payments made for the cost reporting period covered by the most recently submitted cost…

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Healthcare Improvements

December 21, 2012

So nice to see so many changes being considered in healthcare.  Most importantly is to keep the focus on the patient and doing what is best for him/her.  There are so many processes that need improvement which will reduce expenses and costs.  The fear of reimbursement reduction will dissipate when reviewing costs and eliminating waste offsets it.  Let’s work together to do what is best for the patient and the provider will benefit.