As we enter the last month of “summer vacation” we’re starting to see movement from the sleepy industry. We’re rolling-out our next major software update just in time for fall, so that our clients are armed and ready for the busy season. While many of us were enjoying the seasonal splendors of the years’ sunniest time-of-year, Congress was busy trying to repeal Obamacare.

Let’s dive into these changing times.

What Congress and the President did and didn’t do to the Affordable Care Act.

Inaction on the insurance healthcare front is a better alternative to countless uninsured patients if you are a healthcare provider. Maybe a bipartisan approach can produce improvements rather than the complete appeal and replace that we were facing.

For further reading on this topic, read this article in the Washington Post.

Exciting Improvements to Our Technology

On our RCM product, we will see additional improvements towards the standardized defaults to the system; with the ultimate goals always being to provide staff with time efficiency and error reductions. This month’s focus was on insurance default modifiers, the improvement to this has eliminated the need for us to add on claims.

Automating the addition of a standard modifier will allow for one less piece of information to be added to certain insurance claims. This is mainly required by certain Medicaid’s and CMO’s. Another improvement is standardizing the supervisor field for a patient, so that supervisor is on all claims. The financial dashboard will include the ability to see the number of new patients for the month and separate out revenue by locations. This additional information will allow for better visibility on which providers are getting the new patients, and if there is follow through with subsequent therapy. Seeing the location breakdown will also be a nice way to determine how each location is performing.

Common Billing Problems We’re Eliminating

Issues we run into that groups and facilities can relate to are the challenges in setting up electronic remittance for the variety of payers. Between this setup requirement and contracting with insurance we seem to spend almost as much time on the setups for our clients as we do on the claims process itself. There isn’t any standardization in the insurance industry, although CAQH and the two largest clearinghouses Availity and Emdeon (Change) do help with streamlining the setup process, it is still time consuming and disjointed.

Other issues we seem to come across constantly are the way providers organize themselves, both with the Internal Revenue Service (IRS) and the insurance companies. These problems arise from using social security numbers for some insurance, employee ID numbers (EIN) for others and then switching between using individual and group National Provider Identifier Standards (NPI).

We see the need to improve in the software area for obtaining the data we need accurately and efficiently as a requirement that demands a near-constant evaluation. We also value helping groups and providers establish and maintain themselves correctly with insurance so we can then process claims as efficiently as possible, the ultimate goal being paid claims and cash flow that allows the group to both pay its bill and be profitable.

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