Up-Coding, Under-Coding, Right-Coding - Medical Billing Audits what does it all mean? All medical providers receive requests from Medicare or Medicaid entities to provide documentation to review the accuracy of the coding. These inquiries may result in paybacks or recoupment of funds and/or informational letters describing the nature of the findings. Large health care entities [...]
I graduated from Luther College from a double major in Accounting and Management [SHOUT OUT to all the Luther Alum around the world!] I entered a fairly common trajectory for an accounting graduate at the time (all documented in my LinkedIn profile – take a look). I took a position with a public accounting firm, [...]
I was asked to co-present for a Medical Group Management Association (MGMA) certification course on the topic of Financial Management in Healthcare. The session used to be two days, apparently had been reduced to one. Explaining financial concepts is a pretty dry subject – condensing it into a time slot required for the webinar takes [...]
Are you aware how much time your practice spends obtaining prior authorizations for a patient’s care? Are you aware of the clinical knowledge one must know or have documentation for in order to obtain a prior authorization? I have a client that told me he had a nurse consistently sitting on hold with a particular [...]
As I enter the time of year to evaluate employee benefits and as the NEW owner of an existing business that currently doesn't offer health insurance, the expense will be most likely considerably more. I get this. I want the best employees, I want productive employees, and I want to show the world - MY [...]
Premiums, co-pays, co-insurance, deductibles, out of pocket maximums, non-covered services…who really is in charge of your healthcare decisions? Is a provider in-network, out-of-network? Does a patient have control over which lab or radiology provider to choose? Does the patient know whether those providers are in network or out of network? Do your patients know the [...]
Like most professionals in my lifetime I have participated in or led many small-scale and a few large-scale projects. Why does every organization have “project teams” or strategic projects going on? The answer is simple, for an organization strategic growth and continuous improvement is what keeps an organization healthy. Technology ages by the day, your [...]
This past week I was a sponsor at the IMGMA (Iowa Medical Group Management Association) conference held in Cedar Rapids, IA. My business, FinanSynergy, my vision is to be Iowa’s Premier Health Care Experts. At dinner, the very first night I was thrown a curve ball by someone who has long been in medical administration. [...]
April 1 marks the one year anniversary of Iowa Medicaid’s switch to managed care organizations (MCO)s. After being delayed twice (originally slated to start January 1, 2016 – delayed until March 1, 2016, and delayed a final time until April 1, 2016) the MCOs were still not completely staffed or properly trained for the switch-over [...]
Effect on Patients and Businesses The American Health Care Act rolls back individual requirements to carry health insurance. Two provisions of the AHCA would be retroactive to December 31, 2015 include: Individuals would not be penalized for being uninsured The Act would eliminate the employer mandate to provide coverage without a financial penalty Other provisions [...]
