Health systems lose millions of dollars struggling with denials, and the inability to identify and fix the root causes. EqualizeRCM Services recommends a multi-pronged approach to reduce denials.
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The Blog
Radical Changes on EM Payments and Documentation Requirements Proposed by CMS
Centers for Medicare & Medicaid Services (CMS) has proposed radical changes for the new and established outpatient visits (99201-99215) with regards to documentation and creating a uniform payment for evaluation and management (E/M) services, regardless of the level of service reported.
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Top 10 Things to Do for Considering a New EMR or Business Platform
EqualizeRCM Services‘ Partner, Corinne S. Smith, Clark Hill Strasburger, offers top ten list of things to do for companies considering a new EMR or business platform.
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RCM Robots: Optimize and Improve RCM Operations
EqualizeRCM Services’ (ERCM’s) suite of healthcare solutions utilize robotic process automation (RPA) to optimize our clients’ RCM operations. Our subject matter experts deploy RPA to drive efficiencies in resource utilization. By leveraging both our expertise, our international teams and our RPA, we blend the right mix of human and machine capability to capture more revenue for our clients at the lowest total cost of collections.
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Evaluation & Management: CMS Overarching Criteria vs CPT/Documentation Guidelines
CMS has implemented the overarching criterion for E/M services which makes it clear that medical necessity is the driving force of the level of service assignment. Specifically, CMS states in their statement of overarching criterion, “It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed.”
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Critical Indicators: Importance of Monitoring Revenue Health in a Physician Practice
RCM experts at EqualizeRCM Services (ERCM) advise on the significance of monitoring an array of critical indicators. Using these vital pointers, ERCM’s suite of RCM solutions would not only help you in providing some actionable insights but also would propel your RCM performance to the next level.
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MACRA Explained: How to Succeed Under MACRA
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a law that transformed the Medicare payment system for physicians. MACRA shifts Medicare to a value based system, tying your Medicare payments to cost and quality performance by replacing the flawed Sustainable Growth Rate (SGR) physician fee update formula. The goal is to improve care for Medicare patients by transitioning the payment system from volume to value beginning in 2019. The Quality Payment Program policy through CMS will reform Medicare Part B payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care delivery system. Based on their practice size, specialty, location, or patient population, clinicians can decide how they want to participate in the Quality Payment Program. There are two models to choose from:
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