Billing for telemedicine can be tricky as the rules are still forming and the studies are changing on a daily basis.
As the healthcare industry shifts to value-based care, PRMS is committed to ensuring easy transitions for its clients. We closely monitor QPP policy developments and make sure our clients are kept up to speed. We provide our physicians with detailed explanations, so they understand what actions are needed to avoid costly reimbursement penalties.
The second of two participation options within the Quality Payment Program, APMs stands for Alternative Payment Models. Clinicians treating Medicare patients can opt to participate in this more extensive version of the QPP. Clinicians that are eligible and participate can earn larger reimbursement bonuses.
In 2016 the CMS launched the Quality Payment Program. This was a new value-based reimbursement system. Physicians treating Medicare patients must participate in one of two programs with the QPP. MIPS is the more general, broadly utilized system.
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PRMS provides advanced strategies to protect our clients from costly audits and legal penalties. Our staff works extensively with the Healthcare Business Management Association (HBMA) to keep our billing services totally HIPAA compliant. We happily offer our clients advice on how to stay compliant on the front-end.
In recent years, healthcare costs have shifted. Patients have taken on a greater percentage of costs. Now, more than ever, practices must take action to ensure timely patient payments. PRMS has procedures in place to assist our clients.
Physician Revenue Management Services provides billing and collection services to private practices and hospital-employed groups.
A Hospital Based Physician Group practice that employs six physicians, and four mid-level providers and is a Federally Qualified Health Center (FQHC) engaged Physician Revenue Management to assist in correcting billing issues.
Physician Revenue Management Services immediately identified the issue that most affected this practice: the inability to correctly bill its Medicaid “wrap” claims.
The primary payor for this type of practice is Medicaid, and therefore collecting the Medicaid “wrap” money is a vital revenue source. It is crucial the HMO Medicaid products are processed and submitted weekly to ensure a weekly Medicaid “wrap” check is received for both professional and dental claims.
The client suspected an issue due to a continued decrease in revenue, so it engaged Physician Revenue Management Services as its outsourced billing company.
At the time of engagement, the client was implementing a new electronic medical record (EMR), as well as a new practice management system.
Through our extensive research, we identified the major cause for the decrease in revenue was the previous clearinghouse’s inability to submit the Medicaid “wrap” claims correctly. As Physician Revenue Management Services began to work with the new practice management system, we identified the new clearinghouse also was unable to correctly transmit the Medicaid “wrap” claims.
Physician Revenue Management Services researched the market and identified a local clearinghouse that had previous experience in this unique billing requirement for FQHCs. Our professionals began to work with this new vendor to ensure the client received the maximum amount of revenue for their center. Within a few weeks, the client successfully began receiving weekly Medicaid “wrap” checks.