Up-Coding, Under-Coding – Huh?

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 [...]

By |2020-04-28T12:42:09-05:00August 5th, 2018|Finance, Financial, Healthcare|Comments Off on Up-Coding, Under-Coding – Huh?

ACCOUNTING vs. BOOKKEEPING

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, [...]

By |2020-04-28T12:42:09-05:00June 24th, 2018|Business, Finance, Financial, Healthcare, Medical, Small Business|Comments Off on ACCOUNTING vs. BOOKKEEPING

Medical Financial Management

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 [...]

By |2020-04-28T12:42:09-05:00May 28th, 2018|Finance, Healthcare, Management, Medical|Comments Off on Medical Financial Management

Prior Authorizations, Denials, Death?

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 [...]

By |2020-04-28T12:42:09-05:00August 13th, 2017|Finance, Healthcare, Medical|Comments Off on Prior Authorizations, Denials, Death?

Caught in the Middle

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 [...]

By |2020-04-28T12:42:10-05:00March 30th, 2017|Business, Finance, Governments, Healthcare|Comments Off on Caught in the Middle

Provisions of the American Health Care Act – Part 1

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 [...]

By |2017-03-18T20:08:51-05:00March 18th, 2017|Finance, Financial, Governments, Healthcare, Human Resources, Medical, Small Business, Taxes|Comments Off on Provisions of the American Health Care Act – Part 1

American Health Care Act 2017

The Republicans did it, they put out their “repeal” of the Affordable Care Act. Forty-nine days into the Trump administration the American Health Care Act was unveiled. I could launch into rhetoric about how flawed the bill is or how keeping key aspects of the ACA isn’t truly repealing it. Instead, I reflect on a [...]

By |2020-04-28T12:42:11-05:00March 11th, 2017|Finance, Healthcare, Small Business|Comments Off on American Health Care Act 2017

Auditing Adjustment Codes

What do adjustment codes do on the payers’ explanations of benefits? These codes tell the payee – the provider why all the money charged was not collected. Perhaps it is a contractual adjustment (difference between what was charged and what the contracted rate with the payer is). Perhaps there is patient liability. There might be [...]

By |2020-04-28T12:42:11-05:00February 26th, 2017|Business, Finance, Healthcare|Comments Off on Auditing Adjustment Codes

Fair Pay – in Medicine

What is the first thing that comes to mind when you think about fair pay? Minimum wage? The pay gap between men and women? What about a profession that is reimbursed derived from political processes trying to keep costs under control? A profession that requires at least eight years before using your skills? Education costs soaring [...]

By |2020-04-28T12:42:11-05:00February 12th, 2017|Business, Finance, Governments, Healthcare|Comments Off on Fair Pay – in Medicine

Emotional Contracting

Yawn. The most BORING topic – yet one of the most important for medical providers. With thirteen plus years in medical accounting/patient billing, I know this is a commonly overlooked detail. Do you know all the payers with whom you are contracted? Do you know all the payers who pay you? How often is this reviewed? [...]

By |2020-04-28T12:42:11-05:00January 2nd, 2017|Business, Finance, Healthcare|Comments Off on Emotional Contracting