Blog

HIPAA Compliant Telemedicine

How to Choose Best HIPAA Compliant Telemedicine Software

Telemedicine software allows certain health services and information to be provided digitally to patients. This is particularly useful in recent times when there is a need to avoid face-to-face contact. But it also makes medical care obtainable to remote communities that are otherwise not easily accessible. There are many software options available, and this article will provide a side-by-side comparison of some of the most popular offerings on the market. Allowing you to choose the best HIPAA-compliant telehealth platform that will best serve your needs.

How to Select the Best HIPAA Compliant Telemedicine Software

Developments in IT and mobile technology mean that telemedicine software platforms have become more affordable and capable. The use of telemedicine software will allow doctors and physicians to participate in live video chats with patients, answer questions and concerns, and diagnose their illnesses. It includes applications that allow healthcare providers to reach patients. Who cannot travel or who are located in rural areas.

It can also allow doctors to remain virtually present at a patient’s bedside or in an ambulance during an emergency. Telemedicine solutions also enable researchers and pharmaceutical companies to conduct clinical trials. And provide fast, better, and convenient testing on a variety of subjects.

Telemedicine software is designed to be easy to use for both doctors and patients requiring assistance. You are free to use the kind of application or software that best suits your needs. While the types of telemedicine systems can vary, it is important to consider one key factor when deciding which one to use. Whether they are HIPAA compliant. HIPAA-compliant telemedicine services also provide greater protection for a patient’s electronic health records.

Privacy is a general concern in healthcare, and telemedicine can reveal privacy by digitising a patient’s file. Without proper security, these files are at risk of disclosure. Here we have mentioned some essential features to look for in a telemedicine app that can help you choose the best one easily.

Running a Web Search of the Telehealth Platform With HIPPA:

Most often, telehealth vendors with a strong HIPAA compliance initiative will likely have a dedicated page on their website. That states that the vendor complies with its HIPAA obligations as a business associate. If a web search for a vendor only provides a general statement of HIPAA compliance. That telehealth vendor may not be the best choice. If the healthcare organisation is still interested in this potential telehealth vendor, the healthcare organisation should contact the vendor directly. And request documentation of its internal privacy and health information security policies.

Accessibility to Patient Documentation and Medical History:

Healthcare providers rely on patient records and medical history to diagnose and treat various conditions. That’s why easy access to patient documents and medical history is essential for telehealth appointments. HIPAA-compliant telehealth software often allows providers to easily retrieve patients’ health documents when they are logged into the platform. This is due to the two-way interface that uses two-way communication between the EMR platform and telehealth. Any information you would generally find in a paper chart, such as medications, diagnoses, and allergies. And vaccination dates can generally be found in an electronic medical record.

Also Read:

Provide an Excellent User Experience:

The telemedicine resolution you select should enable clear and seamless communication between patients and providers. To this end, it should be:

  • Simple installation
  • Easy to use and update
  • Intuitive
  • Effective
  • Reliable
  • Independent of third-party software

Choose web services. Patients, especially the elderly, are unlikely to download apps.

Ability to Improve Internal Workflow:

HIPAA-compliant telehealth software can help improve internal workflows. With an integrated telehealth experience, healthcare providers can practise only within the telehealth platform. After logging into the platform, providers can see incoming patient requests and see which patients are in the virtual waiting room. Within the platform, providers also have access to medical records and patient notes. During the appointment, the provider can document information and then create a visit summary without having to log out. Once integrated with the EHR, the systems can communicate with each other and improve internal workflow.

Meets Security Requirements:

This is one of the most important questions to consider because data security is essential in healthcare. The telemedicine platform you choose must comply with the HIPAA security rule, which states that:

  • The integrity and privacy of electronically protected health information (ePHI) should be guaranteed.
  • ePHI should be accessible only to authorised users.
  • Transmitted data should be encrypted.
  • Stored data should never be accessible outside the system or a monitoring system should be implemented to prevent accidental data breaches.

See the Cost of All Available Software:

ROI with cost analysis is essential when purchasing software. Cost-effective software that carries zero to no chance is the preferred choice of all hospitals.

Check How Reliable the Provider is:

Remember, it’s best to choose a vendor that offers a platform tailored to your specific needs. Search for provider reviews.

Look for its Services and Support System:

The best telemedicine software offers an excellent level of service or support to improve the healthcare delivery system. It should be easy to use and set up so that virtual healthcare results are as reliable as in-person services.

Make sure it offers the following services and support systems:

  • Convenient and easy training for doctors and patients.
  • Easily accessible.
  • Video and audio support meeting or call.
  • Support service for any software assistance.
  • Without any glitches and in case of any problems, the software can respond quickly and solve the problem.

Account and Billing:

The ability to automatically invoice clients after an appointment, and access account history. And sending details to insurance companies will enable more efficient administrative processes. It is convenient to allow the client to pay online, including co-payments.

HIPPA Certified:

The Health Insurance Portability and Accountability Act (HIPAA) has approved measures to ensure that any sensitive patient data is safe from misuse. This eliminates the need for additional communication tools. And allows you to easily use telemedicine software as an ideal platform for secure communication.

However, if you use any external non-medical software, keep in mind that it can pull all the essential records from the HER. Therefore, it is necessary to use telemedicine software only for a secure medical consultation.

Conclusion

As technology advances, we can expand our scope of practice far beyond the clients and patients we see in person. Especially in light of our current global situation, telehealth is extremely important in providing care to those who need increased flexibility and availability.

Telehealth software for doctors makes it possible to reduce the number of cancellations due to work, childcare, or travel. Because appointments can be held remotely. It also creates more opportunities for client engagement and relationship building between you and your client.

Read more...

10 Recommendations for a Successful Credentialing Process Flow

If you plan to start your practice or bring new doctors into an existing practice. Your accreditation process must begin well in advance. It is important to understand how accreditation can significantly affect the speed of your cash flow. And how smoothly your practice runs. Ignoring the authorization process will result in delayed cash flow and difficult scheduling due to patient restrictions. Since accreditation issues can be expensive and reduce productivity. It is essential to have a process and plan in place to ensure accreditation remains current.

Recommendations for a Credentialing Process

Here are;

1. Appoint a Credentialing Coordinator:

Whether you outsource credentialing tasks or handle them in-house, appointing a credential coordinator to monitor deadlines and expirations is a wise business decision. They can send out timely reminders to ensure that no one’s credential expires. And refunds are not denied as a result.

2. Create a Sustainable Credentialing Process:

Creating a credentialing workflow can be testing, but it helps in the long run. Your workflow should maintain all required forms and documents, even if you outsource the authorization process. It seems that with a multi-physician practice always comes re-accreditation. And a workflow that accommodates it greatly benefits the practice.

3. Make Use of Advanced Software for Monitoring:

You don’t have to rely on administrative staff to manually monitor your compliance. The cloud-based billing software allows you to easily monitor the status of your credentials from anywhere, anytime. These platforms give you the ability to set up alerts to let you know if a task is about to expire or is due in your RCM cycle.

4. Outsource Medical Credentialing Services:

Medical accreditation can be a time-consuming process. Plus, small missteps in the process lead to frustrating problems later on. Therefore, working with a medical accreditation service provider like Prognosis can be one of the best tips you can follow. When you enter provider credentials using a service like Prognosis. A medical credentialing specialist will review the credentials in the provider registry. Within the organisation and ensure that everything is recorded as it should be.

5. Track Credentialing Applications:

Once authorization requests are sent to the insurance company or organisation, be sure to track the progress of that request. Feel free to contact the insurance company to find out where the application is in the acceptance process. It is not uncommon for payers to delay applications that lack information. Thereby delaying the timely notification of providers.

6. Provide Current Copies of Paper Documents:

For insurance companies that still require paper applications. Your credentialing specialist will need to submit hard copies of licences, DEA certificates, malpractice documents, and other documents, all of which must be current. If some documents are expired or contain incorrect information. This will delay the credentialing process as it takes time to receive and send updated versions of these materials. If some of these documents are submitted to the carriers. This will further delay the process as the insurance companies will then have to redo the new documents.

7. Identify Potential Risks:

  • It is essential to identify potential risks early in the commissioning process.
  • The applicant is not willing to provide all the required documentation.
  • Clinical or coverage gaps.
  • Sudden Termination of License or Privileges.
  • Have short tenures in multiple organisations.
  • An unusual number or history of malpractice investigations or lawsuits.
  • Alcoholism/drugs/domestic violence/history.

If any of the warning elements are present in an applicant’s history. A follow-up interview may clarify the information or a more formal investigation may be required depending on the level of seriousness. Tell the candidate how you plan to proceed in both directions.

8. Stay All Physician Contact Information Up to Date:

The medical accreditation process usually involves various forms of submission. So clear communication throughout the process is very important. Without direct contact, credentialing or credential renewal issues can take longer to resolve than they should.

It’s equally important to ensure that your employees quickly update all important platforms. And channels within your process to correct incorrect or outdated information.

9. Require Peers References:

Our recommendation is to request three peer references from physicians in the same specialty. Who are not current members of the same practice or relatives? If you are going to set these standards for cross-references. Be sure to supply your specifications to applicants for this application.

10. Be Patient with the Credentialing Process:

Credentialing is a long and complex process with many components and steps. You should communicate regularly with your Accreditation Specialist about the progress of accreditation and re-accreditation of your physicians. Make sure you get regular updates and don’t hesitate to ask any questions.

Also Read:

Why is Credentialing So Important?

Medical accreditation is increasingly important because it is the only procedure that allows patients to confidently place their trust in their chosen healthcare providers. RMB credentialing processes offer organisations efficiencies. Reducing the burden on all stakeholders and positively impacting quality. And in the process of verifying that a provider meets standards set by a state, employer, or insurance company.

Why Does It Takes So Long?

Once hired, health professionals cannot begin work at their new facility for several weeks to six months due to credentialing. On the provider side, the process only takes about three hours as they submit around 20 different credential forms. For facility staff, credentialing takes about 20 hours per provider as they perform several tasks that may include:

  • Start a seriousness check.
  • Collect and evidence credentials, clinical reputation, and case histories.
  • Collect and review claims, privileges, and board history.
  • Check penalties with the Office of Inspector General (OIG).
  • Start by verifying primary sources such as the American Medical Association (AMA), medical boards, and educational history.
  • Adjacent files to credentialing committees, executive committees, and facility stakeholders.
  • Create a Bill of Rights and provide a letter of appointment.

Conclusion

Medical accreditation is undeniably important. It ensures that patients receive care from GPs with the correct credentials to give them the highest possible level of care. Therefore, payers undoubtedly make sure that care providers are properly qualified. They do this by following a strict system of checks to look for the correct credentials when submitting a medical application. Even with tips on best practices for medical accreditation, the accreditation process is complicated and time-consuming to navigate. Bringing in an expert with certification experience brings new efficiency to the process.

Read more...
Review Your Revenue Cycle Process

How to Effectively Review Your Revenue Cycle Process

The healthcare industry is large and there needs to be a proper revenue cycle to function properly. Without a proper and functioning revenue cycle, hospitals will not be able to fulfil their promise to provide superior healthcare services to their patients. Revenue tracking from the first patient appointment to the very end of the reimbursement process is managed by revenue cycle management services.

The start of the revenue cycle can be marked when a patient schedules an appointment with their doctor. After the patient receives all services, the hospital receives reimbursement for the medical services it provided to its patient. This means the end of the revenue cycle.

Effective Steps to Review Revenue Cycle Process

Here are;

Current Process:

When evaluating your revenue cycle, you should also take the time to review the process itself. There are many moving parts to your revenue cycle, from initial registration to subsequent underwriting. Looking at the process step by step allows you to analyse the workflow and time required to complete each step of the process. Which can shack light on areas that need improvement.

Key Performance Indicators:

To fully understand your revenue cycle, you need to have a good understanding of your practice’s KPIs. Once you’ve determined them, compare them to industry best practices. Performance metrics to consider include net collection rate, days on account, and more. This type of analysis will permit your practice to identify opportunities for improvement.

Benchmark Against Peers and Competitors:

By understanding the current state of your revenue cycle process, you can benchmark it against your competitors and industry peers. This allows you to identify areas where your organisation is doing well. And areas where improvements could be made. For example, if your peer hospitals see an average payment of 90 days. While your organisation has an average payment of 120 days. You know your process could be improved.

Patient Registration:

Getting the right patient information in the early stages can make or break your revenue cycle management success.

Inaccurate patient data leads to delayed processes and incorrect data. Which is critical to monitoring and measuring RCM effectiveness.

It is good practice to encourage the pre-registration of patients. This allows for a more careful review of patient information and prevents claim denials.

Modernise Claims Processing:

Claims cleaning is the process of ensuring accuracy, correctness, and completeness before claims are submitted to insurers. It’s an easy way to improve your chances of getting paid instantly. And it’s another task that lends itself well to automation.

Instead of the long and laborious manual labour that cleaning used to require. Modern software has made the process almost instantaneous. There is simply no reason why your practice should ever submit a claim that has not been vetted by your internal clearinghouse.

Staffing Plans:

Your plans should also assess your firm’s workforce levels. Review procedures with your team to determine the people needed for each stage of the process. And how much time will be spent affected by variables such as specialty, patient information, and technology needed? You can also use this opportunity to address any future staffing requirements. That may arise as a result of your new goals.

Patient Collections:

This has been considered one of the most important stages of any medical billing system. The process of tracking payments due requires patience and diligence.

A good revenue cycle management system will help you provide an adequate explanation of insurance coverage to your patients and support payments.

Denial Management:

In general, denial management can involve any aspect of the revenue cycle that may result in no or low reimbursement. Reasons for denial may include incomplete or inaccurate insurance information, lack of pre-certification, or prior authorization. Failure to capture all tests or procedures, errors, or omissions in the coding of diagnoses and procedures. Filing of claims out of past limits, or denial due to lack of medical necessity. The best practice is to monitor and track rejections at the time payments are posted. Denials should be pursued by the payer, denial type, and provider.

Inquiring About Revenue Cycle Resource:

When it comes to the revenue cycle, some technologies need to be used to get the right results. It is important to identify the resources and materials used for each of the activities. Discussing with your management team the handling of the process and the resources used is also key to success.

If you want to stay on top of healthcare billing developments. You would need to hire proper revenue cycle management services. As they can look at the timely submission of claims along with looking at all the necessary solutions.

Also Read:

How We Can Better Your Revenue Cycle Process

A thorough evaluation of your revenue cycle can significantly reduce the number of claims denied in your practice. Leading to higher revenue and overall practice efficiency. The Right Medical Billing team specialises in revenue cycle management for medical billing and emergency room practices. And we look forward to working with you to help you succeed.

Our RCM services aim to reduce lead times, avoid replenishment costs and waiting for refunds, and maximise cash flow. In particular, the Right Medical Billing team strives to develop an expert opinion for your practice. Allowing you to get ideas on what needs to be addressed and make the required adjustments.

We are pleased to provide you with a wide range of practice management services to move your practice to the forefront of your industry.

Conclusion

The revenue cycle is an important and complicated process in healthcare organisations. It helps administrators manage patient check-in, billing, insurance verification, clinical documentation, and other processes necessary to maintain financial health while delivering care. It is important to understand that while the revenue cycle process is important to your organisation, it is constantly changing. As an administrator, it’s your job to keep up with these changes and ensure your organisation is always running as efficiently as possible. If you are just starting your journey as a hospital administrator or hoping to take on more responsibility in your current position. This means you are not alone. Hiring an expert team like WWS for your medical specialty makes sense. When looking for help with your management requirements revenue cycle.

Read more...
Patient Experience in telemedicine

Patient Experience in Telemedicine: Meeting the Expectations of Virtual Care

The healthcare industry has seen tremendous growth over the decades due to the simplicity and convenience brought by the advancement of today’s technology. However, there are still many challenges for the industry to overcome, especially in the availability and convenience of services for both patients and healthcare providers.

What is Telemedicine?

The World Health Organization (WHO) raises telemedicine as “healing at a distance”. It is the use of telecommunication technologies and information technologies to provide remote clinical services to patients. Doctors use telemedicine to transmit digital imaging, video consultation, and medical diagnosis at a distance.

Today, individuals no longer need to schedule an in-person doctor’s appointment to receive treatment. Using a secure video and audio connection allows specialists to treat patients who reside in locations with limited access to care.

What is Virtual Care?

Virtual care is part of telehealth patient care. An asynchronous and synchronous remote patient care, including remote patient monitoring, virtual visits, and any other remote form of patient-provider communication. Virtual health technology can take the form of video sessions, emails, text messages, or even lab results delivered online.

Pros and Cons of Virtual Care

There are many advantages and disadvantages to using telemedicine as part of a comprehensive care delivery model. Because the advantages outweigh all the disadvantages, telemedicine is revolutionising the way we care for patients everywhere.

Evolving technologies are making it easier than ever to simplify and streamline telemedicine. For example, a vaccine management program can help you efficiently and helpfully vaccinate your patients while protecting their privacy.

Pros;

o   Telehealth minimises the spread of infectious diseases.

o   Telehealth is convenient.

o   Telehealth can reduce unnecessary emergency room visits.

o   Telehealth can help you improve patient outcomes.

Cons;

o   It is impossible to do a physical exam virtually.

o   The regulations can be confusing.

o   Telehealth may require additional equipment or downloads.

Also Read:

Types of Virtual Care

As noted above, virtual care technology is proliferating across online platforms. These are just a few examples of virtual care using modern technology. Together, they help create a cohesive model of virtual care, including support for virtual urgent care.

Virtual Visits:

Virtual visits form the backbone of virtual care services. Using video conferencing directly for patient care, virtual visits offer instant access to healthcare providers for everything from annual checkups to treatment of chronic conditions.

Live Chat Messaging:

Live chat gives new and returning patients an intuitive way to determine what help they need. By messaging doctors in real time, patients can access professional advice on how to treat symptoms and whether they need a virtual or in-person visit.

Digital Self-Care Tools:

Digital self-care tools use the same concept as live chat when doctors are less available. Designed around patient needs, these tools collect data and guide patients based on automated expert medical advice. Once a doctor is available or needed, he treats patients accordingly.

Expectations of Virtual Care

Here are;

Telemedicine Helps Increase Patient Base and Revenue:

Telehealth improves access to healthcare and expands the reach of medical professionals to ensure more patients. A growing number of HCPs from most states are using telehealth because of the benefits it provides them in improving access to medical care and reaching patients regardless of their location.

Greater access and expanding reach to patients also allow practices to increase revenue. Offering telehealth services expands your patient base, from rural to urban patients, through convenience, lower cost, and less hassle. Patients prefer to experience a more advanced and modern medical practice available through telehealth.

Increase Patient Engagement:

Patients are becoming more tech-savvy and even more health-conscious with the rise of telemedicine and the wide variety of healthcare apps available today. Telemedicine increases patient engagement by helping them keep follow-up appointments and care plans.

Virtual consultations also make it easier for patients to contact their doctors, report early warning signs or any health problems, and keep their appointments.

Convenient and Easy to Access Care:

The original goal of telemedicine is to provide healthcare services to patients in remote or rural areas and to offer solutions to problems such as the shortage of doctors and medical facilities. Smaller hospitals in rural areas are also able to provide intensive care services with the help of specialists in other facilities through remote patient monitoring systems.

The use of telemedicine has also expanded to reach patients even in urban areas who have busy schedules and lifestyles. Less willing to waste time travelling to a hospital or clinic and waiting in line at a doctor’s office, patients are looking for more convenient ways to get immediate, on-demand care.

Telemedicine Helps Reduce Patient No-Shows:

When HCPs implement telehealth options, patient no-shows are reduced. Because telehealth satisfies patients’ desire to control their schedules and easily cancel or reschedule appointments, there is a significant reduction in patient no-shows.

Allows you to create HIPAA-compliant text messages and appointment reminders via SMS. Best of all, your patients can reply via text if they need to reschedule, cancel an appointment, or have any questions.

Why Do Healthcare Systems Need Telemedicine?

Rising healthcare costs and the need for better treatments are motivating more hospitals to explore the benefits of telemedicine. They want better contact between doctors and remote patients and better use of medical facilities. Here, telemedicine also promotes better connectivity, which has resulted in fewer readmissions and patients who are fully compliant with their prescription care plans. The increased contact advantage of telemedicine also extends to physician-to-physician communication. Doctors can use telemedicine to build support networks to exchange their skills and provide better healthcare services. Telemedicine is a method of providing medical care over the Internet, usually via video chat. This technology has several advantages for both patients and healthcare providers. Although there are still technical hurdles and critics, telemedicine can complement and improve the overall patient experience.

Conclusion

Telemedicine has improved health results in some contexts, such as mental health patients and patients with cardiovascular disease in high-income people country but the findings are very mixed and generalisation is difficult. Barriers to the adoption of telemedicine include poor computer literacy, lack of high-speed internet, outdated equipment, low usability of applications, lack of interoperability, resistance to change, high costs, and privacy concerns.

Read more...
Patient Experience in Specialty Care

Patient Experience in Specialty Care: Challenges and Solutions

There’s no easy way around it: understaffing has an impact on patient safety and experience. A quality patient experience has a positive impact on patients and their families as well as healthcare facilities. Above all, patients want valuable and high-quality care. The quality of your patient experience reflects your hospital’s ability to retain and attract new patients, but that will be difficult if you’re trying to maintain a full staff. With the right staffing, it is much easier for doctors and patients to develop a positive relationship, a sense of loyalty, and increase patient retention.

We are going to discuss about challenges and solutions of Patient Experience in Specialty Care.

Patient Experience in Specialty Care

What is the Patient Experienced?

Patient experience includes the many interactions patients have with the healthcare system, including care from their health plans and doctors, nurses, and staff in hospitals, doctor’s offices, and other healthcare settings. As an integral part of healthcare quality, patient experience includes several aspects of healthcare delivery that patients value highly when seeking and receiving care, such as timely appointments, easy access to information, and good communication with healthcare providers.

Understanding the patient experience is a major step in moving towards patient-centred care. Looking at different aspects of the patient experience can assess the extent to which patients are being provided with care that respects and responds to the patient’s individual preferences, needs, and values. Evaluating patient experience, along with other components such as efficiency and safety of care, is essential to provide a complete picture of healthcare quality.

So, scroll down the page to check the Patient Experience in Specialty Care.

Insufficient Insurance Coverage:

A lack of insurance often contributes to a lack of health care. The challenge is dire and far-reaching: The financial need and lack of coverage to pay medical bills can lead people to miss out on essential care for themselves and their families, including preventive checkups, dental care, and visits to paediatricians who monitor important children’s health milestones. The lifelong health consequences of missing these appointments have prompted many health systems to launch initiatives that provide services to uninsured or underinsured patients.

Also Read!

Patient Engagement Increase:

When patients have a quality experience thanks to the right staff, their loved ones are likely to be more involved. Increased engagement can reduce the likelihood of medical error and patient length of stay. When clinical indicators are at peak quality, pain management and mental and emotional health are improved.

By ensuring good relationships between healthcare providers and patients, patients are more likely to ask more questions. They are also more likely to adhere to the treatment measures that have been recommended to them.

This is how the Patient Experience in Specialty Care exist.

Demystify the Financial Implications of Healthcare:

Most consumers remain confused when it comes to how their decisions will affect their costs or how those costs can be balanced against likely outcomes. One of the main needs identified was advice on the financial implications of healthcare decisions.

Look for Ways to Ease Call Volume Pressure for Physicians and Clinicians:

It’s staggering how much time specialty teams spend on the phone, whether it’s answering patients’ questions, helping them access medications or treatments, or planning the next steps in care. Urology practices are increasingly exploring ways to use nurse practitioners, physician assistants, and other healthcare professionals to answer patient questions in a professionally fulfilling way. One approach is to allow nurses and medical assistants to upload videos that provide answers to the most frequently asked questions by the condition — such as treatment and management options for overactive bladder or what to expect after a vasectomy — in a language that most patients will understand.

Nurse practitioners and physician assistants are well-versed in answering questions from family members and caregivers. These frequently asked questions about the video and their corresponding answers can be provided to the relevant patients and their caregivers. By leveraging data from practice management systems and EHRs, specialty practices can identify which patients might be interested in certain videos and send them in real-time via a patient portal, email, or SMS. Resources like these give patients more confidence in navigating their condition. They also relieve administrative pressures.

By doing this we can increase the Patient Experience in Specialty Care.

Upgrade Your System:

Many things can affect a patient’s satisfaction or dissatisfaction before they even see a member of your team – one of which is not meeting the client’s expectations. For example, scheduling can be a significant issue for clients, especially when systems are outdated or difficult to use. Changes in the overall market mean that customers expect a certain level of intuitiveness in every setting they use.

Support Consumers as They care for Others:

Caregivers Are Actively Seeking Ways to Improve Their Population With the expanding senior population, it is critical for healthcare organisations to find ways to serve this demographic.

Expand Insurance to Cover Health Care Costs:

According to the National Center for Health Statistics, 31.6 million people of all ages were uninsured in 2020. These people are often employed people or dependents of employed people – including 3.7 million uninsured children.

There are many reasons for this growing trend. As the cost of insurance continues to rise, many companies can no longer offer it as a benefit to their employees. Shopping for insurance in the private market often leaves people with expensive policies and plans with high deductibles. For some, it’s an expense they simply can’t afford.

This is how to improve Patient Experience in Specialty Care.

Adults aged 18 to 64 living in Medicaid expansion states were more likely to be insured, more likely to have private insurance, and more likely to have public insurance compared to adults living in non-expansion states.

Government initiatives designed to help uninsured individuals secure health care coverage through state and federal programs help mitigate the impact of being uninsured as a barrier to health care coverage.

Conclusion

Many people cannot afford to see a doctor; some don’t even have one nearby. Addressing these and other major barriers to healthcare access have become a critical mission across the continuum of care. But as the parties involved are learning, it won’t be easy.

Health systems face these and other operational challenges at the same time as workforce shortages, financial strains, and policy changes in a growing industry. As healthcare leaders work to improve population health within these constraints, they are harnessing the power of technology to help, from physical education to telehealth. Access challenges are significant, but with dedicated tools and engaged stakeholders, a brighter future is possible.

Hope you have find solutions of all challenges in Patient Experience in Specialty Care.

Read more...

Navigating the Complexities of Medicare and Medicaid Insurance for Patients

Medicare and Medicaid save lives, help people live longer, and provide peace of mind with affordable healthcare that’s there when you need it. Chances are you or someone you have either Medicare or Medicaid in your family, or you know someone who does. Medicare and Medicaid cover nearly 1 in 3 Americans—that’s more than 100 million people.

More than 57 million seniors and disabled adults depend on Medicare, but too many struggle to enrol and navigate the complexities of the federal health insurance program, a national advocacy group says.

Care navigation is a broad category of solutions that help patients avoid these barriers and succeed in achieving their health goals. In practice, this can look like helping with:

  • Administrative matters: understanding health plans and insurance.
  • Clinical understanding: exploring and explaining options in prevention, care, and treatment.
  • Patient care experience: patient advocacy, care coordination, and finding the right care.

What is Medicare?

Medicare is federal health insurance for people over age 65 and some people under age 65 with certain disabilities or conditions. A federal company called the Centers for Medicare & Medicaid Services runs Medicare. Because it is a federal program, Medicare has set standards for costs and coverage. This means that a person’s Medicare coverage will be the same no matter what state they live in.

Bills related to Medicare are paid from two trust funds held by the US Treasury. Trust funds are funded by a variety of sources (including payroll taxes and funds authorised by Congress). People with Medicare pay some of the cost through things like monthly premiums for medical and drug coverage, deductibles, and coinsurance.

What is Medicaid?

Medicaid is a joint federal and state program that helps cover medical expenses for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state operates its program. This means that eligibility requirements and benefits may vary from state to state.

Medicaid offers benefits that Medicare does not normally cover, such as nursing care and personal care services. People with Medicaid usually pay nothing for covered medical expenses, but they may owe a small copayment for some items or services.

Also Read:

Save From the Complexity of Medicare

Medicare is a complicated insurance program that beneficiaries – and even professionals can be difficult to navigate. Understanding the basic features of the program can help in accessing its benefits and minimising costly errors.

Proactive Education:

Helping your people understand the intricacies of Medicare. Such as plan options, enrollment periods, and fee structures, early on can help reduce employee stress later on. Reaching out to health insurance professionals (like us) to help educate employees about these concerns. And discussing the various options available to them can ensure they receive the best coverage for the services they need.

One of the reasons Medicare is so complicated is that it comes with multiple options. Some features of Medicare that employees need to consider are:

  • Part A – Hospital insurance which covers hospital care and patient care.
  • Part B – Health insurance that covers outpatient and medical care.
  • Part D – Prescription drug coverage includes most self-administered prescription drugs.
  • Medicare – includes Part A, Part B, and the option to add Part D
  • Medicare Advantage – considered an all-in-one alternative to Medicare and includes Part A, Part B, and sometimes Part D, as well as other benefits such as vision/dental, etc.
  • There are also premiums, deductibles, and copays to consider.

Practical Concerns:

Addressing concerns like these can help employees confront financial burdens later. Like penalties, late fees, and over contributions. In other words, you as the employer can have a significant effect on your employees’ lives. You can make them more financially stable and eliminate huge sources of stress.

By setting up consultations with an expert to talk about their health insurance requirements. You can show your employees that you truly need the best for them. And they can feel comfortable knowing they are making smart changes.

Medicare can be a difficult idea to navigate, leaving many employees confused and overwhelmed. Some even avoid enrollment entirely. But the more information your employees have, the more nurturing the benefits plan is, and the more comfortable. And optimistic your employees will be about making the transition into Medicare and retirement.

Save From the Complexity of Medicaid

The health care system itself is complex. However, Medicaid recipients often have to navigate different programs, agencies, and rules. The complexity of Medicaid regulations and program design can be unnecessarily difficult for enrollees. A fragmented benefit design means that individuals receive behavioural health from one health plan, physical health services from another, and long-term services and supports (LTSS) from another agency. This is inefficient, frustrating, and leads to poor results. Nearly 1 in 5 Medicaid consumers say it’s difficult to know who to call when they have questions about Medicaid insurance.

Improving the quality of Care

Navigation services also facilitate patient-centred care or care in which the patient is prioritised as an active participant in their health decisions. This leads to increased patient satisfaction, better outcomes, and more cost-effective care. It contrasts with the more traditional model of the paternalistic doctor-patient relationship, which assumes that healthcare providers are more informed than the patient about the patient’s clinical condition. Instead, a shift toward physician-patient collaboration is underway. Following a flurry of digital health innovations and increasing access to medical information online, navigating care provides patients with more resources to make informed decisions.

Conclusion

Choosing a health plan shouldn’t be a frustrating experience. Policymakers have a big opportunity to help consumers if they take several steps now. The development of high-tech and high-touch decision support requires a long-term. And the consistent interplay between the public and private sectors. Innovation in the private sector can improve service levels for all if policymakers work with the private sector to enable the use of data. By setting a policy with explicit roles for the public and private sectors, innovative decision support can finally make choosing Medicare coverage easier.

Read more...
Patient Insurance Benefits

Managing Patient Insurance Benefits in a Multi-Provider Practice

Healthiest Group Practice and Organisational Practice Management System were designed to help our providers and administrative professionals within the organisation manage all of their office and facility needs – our organisation’s functionality extends to scheduling, billing, payment processing, and client paperwork/forms, as well as enabling internal team communications that are HIPAA compliant. Providers, assistants, and other administrators each have their accounts for secure management. Healthier offers an internal platform for sharing calendars, invoicing, group intake forms, and much, much more.

So, we are going to discuss about Patient Insurance Benefits.

What is Patient Insurance?

Health insurance helps pay for your health care. It can help cover services from routine doctor visits to major medical expenses due to a serious illness or injury. It also includes many preventive services to keep you healthy. For health insurance, you pay a monthly bill called a premium, and you may have to pay a portion of the cost of your care each time you receive medical services.

What is Care Management?

Care Management is patient-centred team coordination of patient care and chronic conditions. By more effectively integrating various preventive care support systems, Care Management programs reduce the need for medical services and improve outcomes for managed care organisations.

By promoting patient engagement and self-management, these innovative programs eliminate duplication and simplify care coordination for care managers and care teams across specialties.
Electronic medical records (EMRs) cannot achieve the kind of care coordination necessary to meet the needs of today’s proven value-based care model. A robust Care Management program integrates data from all sources, stratifies patient risk, organises patient intake, and manages the coordination of patient care and care managers—all while measuring the performance of the care team.

Scroll down to check out all Patient Insurance Benefits.

The technology needed to support effective care coordination goes far beyond simply digitising a patient’s medical history. While EMRs are essential resources for data collection and storage, they are not the interactive workflow tool that cares teams need to make timely and informed decisions to minimise readmissions.

Insurance Verifications Elements

  • Participation
  • Co-pays
  • Additional insurance
  • Payable benefits
  • Patient policy status
  • Effective date
  • Plan type and coverage details
  • Plan for lockouts
  • Address for sending complaints
  • Recommendation and Prior Authorization
  • Maximum lifetime and more.

Also Read:

Patient Insurance Benefits

Here are;

Provide Protection:

Insurance coverage reduces the impact of loss that one bears in dangerous situations. Provides cash compensation during financial crises. Not only does it protect the insured from financial difficulties, but it also helps in controlling the resulting psychological burden.

Economic Growth:

Insurance contracts mobilise household savings to ensure financial stability. It also aims at mitigating losses due to damage or destruction to the insured community. It not only spreads the risks equivalently but also promotes trade and commerce by leveraging the fund.

These are the Patient Insurance Benefits.

Negotiating Health services:

Health insurance companies use their market power to obtain price concessions from doctors or hospitals and healthcare systems or to drop high-cost providers from their networks. Covered patients also enjoy these discounts when paying for services out of pocket (except for prescription drugs, patients often pay list prices even if they have insurance). Policies that focus on this function of health insurance affect the bargaining leverage of doctors and hospitals vis-à-vis insurance companies.

For example, Medicare sets payment rates through fee schedules rather than allowing healthcare systems to use their market power to raise the prices they charge. The Affordable Care Act (ACA) encouraged insurers to build “narrow” networks of doctors and hospitals to help commercial plans win lower rates through increased bargaining power. Consolidation of insurance companies also strengthens the negotiating position of the insurer.

Deductible:

The amount of money you have to pay each year to cover the cost of medical care before your health insurance starts paying you.

Non-Cancellable Policy:

A policy that guarantees you can get health insurance if you pay premiums. This is also called a guaranteed renewable policy.

These are the Patient Insurance Benefits.

Treatment Less Expensive:

When you take out health insurance, you start to benefit immediately. Even if your plan has a deductible — the out-of-pocket amount you have to pay before your full coverage kicks in — you’ll pay significantly less for office visits than you would without insurance, provided the health care providers you see are in your range. Sew. Some plans also offer reduced-cost generic drugs and free disease management programs. Plus, health insurance can put you in a better position to prevent or catch difficult—and often costly—diseases early.

What is Compensated Under Patient Insurance?

  • Malpractice results from the medical examination or treatment of a patient or their negligence.
  • Traumatic damage arising suddenly, unexpectedly, and as a result of an external event during a medical examination or treatment.
  • Device breakage, in other words, the breakage of medical equipment during treatment or examination that results in injury to the patient.
  • Infectious injury due to unexpected infection during medical examination or treatment.
  • Sudden and accidental injury during a medical examination or treatment, such as a patient falling from a treatment table.
  • Injury caused by circumstances in medical facilities or facilities, such as a fire in medical facilities.
  • Injury caused by incorrect medication administration.

How Do We Use a Patient Insurance Policy?

Each insurance organisation has different rules for using health care benefits. When you first sign up for insurance, you should glance at your plan’s benefits and limitations. Especially if the ideas require you to receive care from certain doctors and hospitals, as most plans do. Generally, you will permit your insurance information to your doctor or hospital when you go for care. The doctor or hospital will bill your insurance company for the facilities you get.

These are the Patient Insurance Benefits.

Conclusion

When we think about the importance of health insurance, our mind often goes to the worst-case outline. Insurance is of course essential in case of serious injury or illness. Having health insurance coverage is important, but understanding your policy can be complicated. It is extremely beneficial to know what your policy does and does not cover for any illness or injury in advance so that you know what charges you will be responsible for. This information can help you navigate your policies and use them to your advantage to stay healthy at school. The following common terms are often used by insurance companies to define policies, but this information is not intended to replace the language used in your policy.

Hope you have find all Patient Insurance Benefits.

Read more...
Patient Scheduling

Strategies to Reduce No-Shows and Cancellations in Patient Scheduling

If scheduling appointments is what keeps the practice pumped, no-shows are the plaque that clogs the system. You could provide the best care in the world, but it means nothing if you can’t get people in your door. There are many reasons why people don’t show up for meetings. So, reducing the number of no-shows is a balancing act. To get it right, you’ll need to constantly test different ways to see what resonates best with your patients.

In this article, we are going to discuss about Strategies to Minimize No-Shows and Cancellations in Patient Scheduling. So, keep reading carefully.

Steps to Reducing No-Shows & Cancellation

Here are;

Build a Strong Relationship with Your Patients:

Relationships with patients are the foundation of any dental practice. When patients feel welcome and valued, they are less likely to miss an appointment or cancel it without rescheduling. You can build strong relationships by creating a pleasant environment in your practice. This might mean spending some money to update the waiting room, training staff on how to greet patients over the phone and in person, or even creating a program where you send birthday cards to patients.

It can also be helpful to educate your entire staff on the importance of friendliness and compassion. A nervous patient can be put at ease by friendly conversation and is more likely to make and keep future appointments than one with whom your staff doesn’t interact.

It is good step to reduce No-Shows and Cancellations in Patient Scheduling.

Use Automated Patient Appointment Reminders:

Perhaps the most effective strategy, and probably the easiest, to reduce patient no-shows is to send appointment reminders. Automatic appointment reminders help reduce patient no-shows and increase appointment confirmations. Utilising automated text reminders will ultimately increase patient attendance through better scheduling and slot utilisation.

Communication via text and email has huge potential in reducing missed appointments. Text appointment reminders that are two-way—meaning patients can message you back—give patients a chance to confirm an appointment, get directions, ask questions, and adequately prepare for their appointment.

Allow Pre-Paid Appointments:

Give patients an incentive to show up by allowing them to book an appointment. When patients know they have already budgeted for the appointment, their motivation to show up will be enhanced. You can even offer a discount to patients who book another visit.

This is also good step to reduce No-Shows and Cancellations in Patient Scheduling.

Reward Patients who Keep Appointments:

When a patient doesn’t show up, you can put a small fee on their account that stays until they schedule and keep a new appointment. You can reward patients who keep their appointments and arrive on time with a small discount on their bills. You can also enter the names of your early arrivals into a drawing for a gift card each month.

Calculating Patient No-Shows Rates:

Healthcare provider organisations can take another step toward reducing missed patient appointments by calculating their no-show rate, which is the percentage of appointment time lost because patients don’t show up or cancel at the last minute. The equation is simply to divide the number of no-shows (including late cancellations) by the total number of weekly appointments.

this is good step to reduce No-Shows and Cancellations in Patient Scheduling.

It is important to understand some of the factors that influence a medical practice’s no-show rate, including:

  • Geographical location
  • Patient demographics
  • Planning practices
  • Payer types (commercial insurance, Medicaid, self-pay)
  • Appointment types (new patients vs. established patients; appointments booked well in advance; appointments for certain types of tests or procedures).

Understand Common Reasons for Patients Missing Appointments:

Patients often have valid reasons for missing appointments. Understanding the common reasons for missed appointments can help you realise the importance of sending appointment reminders and confirmation requests. Sometimes patients fail to set their alarms and oversleep, leading to missed appointments in the morning. If the doctor calls late patients, he can wake them up and reduce the number of missed appointments.

So, by doing this you can reduce No-Shows and Cancellations in Patient Scheduling.

Missed appointments are also more common during the holiday season when patients may be distracted or even travelling out of town on the day of their clinic appointment. Scheduling appointment reminders a few days before a health service can prevent missed patient appointments during these busy periods. Personal issues, such as financial problems or advanced medical care at other facilities, can also cause patients to miss medical appointments. Sending appointment reminders can give these patients a chance to cancel their hospital or outpatient appointments rather than becoming no-shows.

Let Your Patients Complete Forms Online:

Filling out forms at the doctor’s office can be time-consuming and frustrating, and for first-time patients, the need to arrive on time can be a disincentive to keeping an appointment. You can respect patients’ time and generally reduce waiting times by allowing patients to fill out intake forms online.

Choosing dental office management software with a robust patient portal can help you implement this best practice. You can even put tablets in the waiting room to allow patients who don’t fill out forms in advance as quickly as they arrive for their appointment.

Send Follow up Messages:

Automating thank-you messages that let your patients know you appreciate keeping their appointments recognizes that their time is valuable and helps build patient loyalty. You can also include additional information for referrals, medications, and any other types of follow-ups in your post-appointment thank-you note.

Also Read:

New Strategies for Reducing No-Shows Rates at Your Practice

    • Avoid a flat rate policy when it’s only a small percentage of your patients who keep missing appointments.
    • Consider limiting same-day or only one-day advance appointment scheduling for chronic no-shows.
    • Don’t focus your efforts to reduce no-shows on a specific day of the week/time of day/time of year. It’s more about your politics than you’re timing.
    • If you know a particular patient is a frequent no-show, consider double-booking a time slot in anticipation of a no-show. That way, you won’t lose income by having an empty slot in your schedule.
    • Many practices use automated appointment reminder systems. Consider additionally and directly contacting the small percentage of your patients who are most likely to be no-shows. A handful of calls today could solve a problem tomorrow.

these all new strategies are valid to reduce No-Shows and Cancellations in Patient Scheduling.

Conclusion

A certain percentage of meeting cancellations is to be expected in business – we all know that emergencies happen. But too many cancellations or no-shows can cost you a lot of time and money and prevent you from building working relationships with other clients. It can seem impossible to get your clients to show up for appointments. But for many healthcare companies, these strategies aren’t groundbreaking. They are rather common. Once you master each one, you’ll win over the patient’s no-shows. You can then focus on other important aspects of running your practice.

Hope you have find all answers of your question about how to reduce No-Shows and Cancellations in Patient Scheduling.

Read more...
Role of technology in patient scheduling

The Role of Technology in Patient Scheduling: Online Appointment Scheduling System

Today’s rapidly digitising world is leaving behind anyone unable to keep up with its speed. This is true in the healthcare industry, where electronic scheduling software has revolutionised medical scheduling by transforming it into immensely beneficial digital patient scheduling. The need for healthcare services increases with population growth, and the number of patients seeking healthcare in hospitals, healthcare facilities, holistic groups, and physician practices has greatly improved. These bring a new set of challenges for facility staff and administrators. Online scheduling software, a recent technological advancement, has made the hospital booking process easier for both patients and administrative staff.

Pros and Cons of Online Appointment Scheduling System

Pros;

  •   It is comfortable.
  •   It facilitates the management of employees and resources.
  •   Increases automation.
  •   Increases customer satisfaction.

Cons;

  •   It is impersonal.
  •   This is difficult for some customers.
  •   You will need to sync your calendars.
  •   Requires reliable internet access.

Also Read:

Online Appointment Scheduling System

Here are;

Email Services:

The main meeting scheduling feature available is email. In marketing, it is still the main point of contact between brands and consumers due to its versatility and dynamism. Moreover, it has a high engagement rate due to its availability through various platforms.

So, we are going to discuss about role of technology in patient scheduling.

The same features that make email a popular channel for marketing communications also apply to the meeting schedule. This is because the meeting scheduling software interfaces with various email services such as Google and Outlook to send reminders to clients. And if you choose it, it can also send email reminders of your upcoming plans. That way, if you’re the type of person who works away from your inbox, you can be sure to keep your appointments with notifications.

Reduces Empty Appointment Slots:

Medical practices are much more likely to fill empty appointment slots when using online scheduling. This is a big advantage for the practice, as empty appointments lead to lost revenue. It allows patients to quickly book same-day or next-day appointments, whether it’s late at night or first thing in the morning. They can quickly check practice availability and book an appointment that suits them.

24 Hours Availability:

Conventional appointment scheduling significantly limits time elements, as patients can only book a slot during clinic opening hours. Online patient scheduling software provides easy appointment scheduling 24/7, even when the medical facility is closed. Patients with other commitments can check the service’s website at any time during their busy schedule and choose which slot suits them best. Patient Pop says 35 percent of their appointments are scheduled outside of the typical 8 a.m. to 5 p.m. Office Hours.

So, by doing this we can learn about role of technology in patient scheduling specially Appointment Scheduling System.

Create an Automated Patient Wait List:

Cancellations and no-shows are an inevitable aspect of any practice, so using a waiting list system is essential to mitigate their effect. Scheduling software often can send mass communication to all current patients asking if they want to have an open appointment. Some vendors also automatically manage waiting lists for their clients. This capability eliminates the need to fill an open appointment with individual calls to patients.

Increase in New Patients:

People are less and less inclined to use the phone. Instead, patients prefer to use a website or app to book an appointment rather than calling the practice. In some cases, patients may feel embarrassed to discuss their problems over the phone. As a result, new patients glancing for a new doctor or specialist tend to be more attracted to those who provide online scheduling. This gives them the freedom to book appointments themselves without having to call someone they don’t know.

By doing this we can also increase improve te patient scheduling with Appointment Scheduling System.

Use Automated Patient Outreach, Recare, and Recall:

A patient recall system ensures that patients return for their regular check-ups. It also keeps the office’s schedule full at all times and can automatically communicate with patients via text messages. Common uses for this feature include follow-up instructions, referrals, and post-meeting surveys. All of these messages serve to bring back patients who may not have had regular care in years.

Patient scheduling is also good techneque to get customer with appointment sheduling system.

Online Payment:

As there will be a payment associated with all services, patients who book appointments online and pay booking fees are less likely to miss their appointments or avoid them altogether. This again reduces no-shows and keeps doctors full. Since online scheduling systems are secure and the information is kept safe, people are satisfied with the payments made online, especially in recent times when countless services are conveniently searched online. Discounts on consultation fees or the offer of a free consultation within a specified period after the first consultation can encourage patients to use the clinic’s online appointment scheduling services.

Reduction in Administrative Work:

Your front office may find it difficult to provide quality patient service if they are trying to do billing, answer phone calls, and administrative tasks at the same time. This leads to long wait times and even rushed customer service, leading to patient dissatisfaction. With online scheduling, staff can spend time providing a positive experience to patients who are physically present in the clinic, freeing up time to complete more complex administrative tasks.

Appointment scheduling system is also helpful in patient scheduling.

Keep Your Customers Updated:

In cases where your company needs to cancel and reschedule meetings for urgent reasons, you will need to send the message quickly and efficiently. Instead of calling your clients one by one, review sending broadcast messages. With broadcast messages, you can transmit a single message to all your clients with a single click. Gradually, use broadcast audio to send a recording instead of a message. Broadcast messages are useful in other ways as well. If there are unforeseen delays, such as road closures near your office, you can notify your clients immediately. This allows them to better plan their visit and the rest of their day.

Conclusion

While online scheduling software has become standard for large businesses, it is not yet the same for smaller businesses. There are still many small business managers or administrators who prefer to use Excel or the traditional pen and register. It’s probably because they’ve always done it that way, and they feel an aversion to technological progress even though it makes their jobs a lot easier.

So, this is how online appointment scheduling system make easy patient scheduling.

However, online booking software is becoming increasingly popular. Its task is to help the owner/manager improve the operation of his business and save resources (e.g., time and money). Most applications are aimed at significantly reducing the time invested in performing daily activities (creating, editing, deleting reservations, issuing invoices, selling additional products and services, modifying tariffs, analysing reports, etc.) Technology also makes scheduling appointments easier for clients.

Read more...
Pharmacy Billing

Pharmacy Billing for Long term Care Facilities: Challenges and Solutions

Pharmacy billing is the profession’s greatest challenge and opportunity this decade and will not be successful without the strong support of pharmacy technicians. Focusing on patient care delivery and health insurance billing in outpatient and community pharmacies requires a fundamental shift in systems and workflows. Technicians play a role in driving the integration of services into the pharmacy workflow and are at the forefront of the pharmacy process.

What is a Long-Term Care Pharmacy?

Long-term care (LTC) pharmacies serve residents of nursing homes, assisted care facilities, extended care facilities, and/or retirement homes. These are usually “closed” pharmacies, meaning that someone cannot walk in and get a prescription filled like at a community retail pharmacy.

Pharmacy Services and Their Types

Clinical

This type of service includes an integrated payment module. It’s essential to handle paperwork, all of which is non-clinical. With this type of billing, you need to be careful about the paper test.

Home care

This type of service involves delivering injectables to patients from home. These services are enclosed by Medicare Prescription Drug Improvement and Modernization (MPDIM). It requires data processing which may not be an integral part of your core competency.

Managed care

This service is similar to clinical services and is provided by large hospitals and nursing homes that realise their reimbursement through a combined payment model. It means heavy non-clinical paperwork and constant report generation.

Radio

This is an important adjuvant therapy service and is covered by the Medicare Prescription Drug Improvement and Modernization Act (MPDIM). It requires intensive professional help with accounting and coding.

Challenges of Pharmacy Billing

Here are few challenges of pharmacy billing;

Lack of Experienced Billers:

Another problem pharmacies face is attrition, which is why they have to make do with less experienced billers. And the cost of doing so is often very high. With inexperienced billers, you have to deal with issues like incorrect coding, incorrect billing calculations, incorrect modifier usage, incorrect primary payer billing, etc. Some pharmacies believe they can overcome this by having a good quality control team. But even the quality control team is prone to error because they are often forced to bite off more than they can chew.

The Audit Specter:

When there are too many errors, the auditor will be knocking on your door. And whether it’s Medicare or other payers, when they come knocking, they’ll leave no stone unturned to uncover flaws in your process. If it is implemented, you will have to face consequences that can range from heavy fines to cancellation of contracts with the payer. So, if you want to keep the auditor at bay, it’s important to have proper control over your process. If not, you may have to conduct regular internal audits with the help of third-party agencies, which is again too costly.

Improving Accuracy:

Filling high-volume prescriptions can turn your pharmacy into a three-ring circus. If your pharmacy serves a long-term care facility, you know that filling high-volume prescriptions on schedule requires fast and clean order processing. Each regulation requires careful monitoring of policies, procedures, and detailed regulations. If you’re managing growth, adding new long-term care (LTC) homes, or acquiring another pharmacy, your challenge is even greater.

A/R is Getting Older:

A/R aging is a common problem faced by pharmacies. It is the most common in all infusion pharmacies. This means that when the oldest accounts exceed 90 days, they enter the realm of write-offs. And when you have more of them, you’re staring down the barrel. And to make matters worse, there are no appropriate means and strategies to deal with it. Therefore, when your high-dollar A/R needs focused attention, you don’t have enough resources to implement a strategy to collect delinquent accounts.

Also Read:

Solutions 

Here are few solutions of challenges in Pharmacy billing;

Prescription Refills:

New or supplemental orders, whether received electronically or by fax, are processed one at a time as directed by the pharmacy. Denied claims, early refills, duplicate documents, and cycle medications are properly processed by the team to ensure patients receive all needed medications on time. They can also work overnight to help the pharmacy get the maximum number of refills on morning drives.

Pharmacy Billing:

We will work side-by-side with your billing team to help you manage daily workloads including income registration, insurance eligibility, prior authorization, census maintenance, payment posting, and pending Medicaid status checks.

How Does an LTC Pharmacy Handle Their Billing?

The LTC pharmacy may bill nursing home residents/facilities on a pre-consumption basis. This means that the resident and their insurance company (or in some cases the facility for home stock items) are billed for the medications before they are issued to the facility. This is usually the same as how the community/chain/supermarket/independent retail pharmacy receives bills. The retail pharmacy charges are based on preliminary consumption. The patient pays for the medication before consuming it.

Preventing Pharmacist Errors

Pharmacists tend to rely too much on technology. With a more personal approach and manual review of each prescription to ensure the request matches the final product, pharmacists can catch last-minute errors.

The problem is the workload, which leads to stress and fatigue. Pharmacists should hire more staff to help ease the burden and give pharmacists more time to fill each prescription. Validating unclear information is also important.

Incorrect Payment Posting in Pharmacy Billing

Pharmacies often have to deal with misbilling outages, especially when they are short-staffed. As a result, this leads to an incorrect A/R calculation. This again leads to loss of income and affects the inflow of income. Without a proper payment posting process, issues keep recurring and some of these recurrences may even lead to rejection.

Your success with outsourcing depends largely on the type of provider you choose. Of course, experience matters most. Always look for a provider that has equal expertise in both pharmacy and medical billing. But along with that, you need to look for suppliers who won’t give you any variable costs, hidden fees, and more. By ensuring this, you ensure that you get value for the money invested.

Conclusion

The roles of technicians continue to expand. They can handle administrative challenges with their attention to detail, deep understanding of pharmacy practices and workflows, and strong technical skills, making them ideal candidates to advance medical billing and pharmacy services.

Read more...

NO – It is not regulated under the gaming authorities of Malta and Gibraltar. Refunds • FAQ TIPPING and Etiquette • FAQ Personal SAFETY • FAQ Booking HOTELS Online • FAQ Language & Allergy Info • FAQ DRIVING LICENCE Requirements • FAQ CHRISTMAS in Thailand • FAQ Floating Markets • FAQ Visit Isaan • FAQ GREAT READS about Thailand • FAQ IMPORTANT LAWS IN THAILAND • FAQ Information on ISLANDS OF THAILAND • FAQ Buses to and from Phuket & Bangkok • FAQ How to find a travel buddy - don't use TA • FAQ Fees for visitors to NATIONAL PARKS • FAQ GETTING MARRIED in Thailand Location within Macau Location Taipa, Macau Address Altira Macau, Avenida de Kwong Tung Opening date 12 May 2007 ; 14 years ago ( 12 May 2007) No. You can use debit cards as well as the prepaid method paysafecard link. Phone Number: (605) 378-3800 Fax Number: (605) 378-3870 • Turtle Creek Crossing Casino P.

Expect brief exchange to determine interest and compatibility. Mrs Egan was a single mother with four children to feed. Personal ads were too sketchy dating in Ethiopia. Single women wanting fuck in Tulsa Oklahoma Looking for a nice fun lady in castro valley u need bj now looking for a girl into scat/pee Saint David Arizona single women play, etc i am looking for girl into scat and pee play!