News

First time clean claims are a leading indicator of a practice’s revenue cycle management maturity. Medicare defines clean claims as those that have ”no defect, impropriety, lack of any required substantiating documentation—including the substantiating documentation needed to meet the requirements for encounter data—or particular circumstance requiring special treatment that prevents timely payment.” In other words, processing…

Given the complexity of revenue cycle management (RCM), many medical practices choose to partner with an RCM company for their billing needs. RCM companies are designed to maximize revenue for medical practices. While there are perks to keeping your billing staff in-house, outsourcing your RCM allows for a team of experts to dedicate their time…

Many organizations we work with have identified and perpetuated a cycle of unbilled encounters by letting them go unchecked. Often, this happens when a doctor sees a patient and doesn’t mark their notes complete or lock it to signify that the encounter is ready to be billed. You’ve got the cost, you’ve done the work,…

RevCycleIntelligence, October 7, 2020 – By Jacqueline LaPointe The new CPT codes allow providers to report nucleic acid assays that allow a single test to detect both COVID-19 and other seasonal viruses, like the flu. In response to the COVID-19 pandemic, the American Medical Association (AMA) is adding two new codes to the Current Procedural…

AMA releases 2021 CPT code set AMA Press Release, September 1, 2020 CHICAGO— The first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services was included in today’s release of the 2021 Current Procedural Terminology (CPT®) code set published by the American Medical Association…

Hillcrest Internal Medicine Shares Their Thoughts on Partnering with RCM360   Developing trusted partnerships that empower healthcare providers to confidently provide care while driving business success is at the heart of what we do. It’s so nice to hear the positive feedback from our partners at Hillcrest Internal Medicine. Read the full Testimonial here. Hillcrest-Recommendation

Navigating Telemedicine Reimbursement in the New Normal On September 16, 2020, TriZetto Provider Solutions is hosting an educational webinar with speaker Elizabeth Woodcock. Elizabeth W. Woodcock, MBA, FACMPE, CPC, Principal at Woodcock & Associates is a professional speaker, trainer and author specializing in medical practice management. Elizabeth has focused on medical practice operations and revenue…

As we all start to look at ways to reduce overhead and improve cash flow, understanding the cost of billing is an important measure for how well your practice is performing. Often, leaders accept the high cost of billing without truly understanding if they are receiving a return on their investment. At RCM360, we can…

  There are several reasons FQHC’s are not capturing the full PPS rate for given services including credentialling issues, code capture, and classifying revenue codes appropriately. Practices also may not receive a full PPS rate because of Medicare Advantage Plans that are not contracted to reimburse at the PPS rate or incorrect forms submissions. In…

In April 2018, the Centers for Medicare & Medicaid Services (CMS) began mailing new Medicare cards to all active Medicare beneficiaries. All beneficiaries should now be in possession of new cards that reflect their individual Medicare Beneficiary Identifiers (MBIs). This new number takes the place of social security number-based health insurance claim numbers (HICNs) used…

Effective Aug. 1, 2019, Anthem Blue Cross and Blue Shield began submitting their Electronic Remittance Advices (ERAs) directly to Availity. As a result, many practices that use the TriZetto clearinghouse platform are not receiving their Anthem Blue Cross and Blue Shield ERAs. This issue is specific to TriZetto-based practices in the following states: California, Connecticut,…

Recently at RCM360®, we became aware of an issue that was affecting one of our clients and could affect many others as well. The situation goes like this… A patient is seen by a doctor in their office. During the visit, the patient has an x-ray performed with the understanding that the cost would be…

According to the Social Security Administration, a “processing error” that occurred in January of this year means that some Medicare beneficiaries’ requests to pay their premiums through a deduction from their Social Security did not go through. As a result, those premiums have not been paid, which means at least a quarter of a million…

“The most important thing we felt about RCM360 is that they felt a sense of ownership when it comes to their responsibility towards getting our money, and we hadn’t felt like we were that important with billing companies in the past.”

I recently returned from the Mini Takes the States road trip, an event organized by Mini USA in which a set of routes is organized, and a large group of Mini owners get together to have a driving experience across the country. We took the Orlando, Florida to Keystone, Colorado route, which was the east…

Revenue Cycle Management is a complete process, from when the patient is seen all the way to collection and filing the claim. Practices are businesses, and they’re seeing the patient for money, and if they’re not managing their revenue cycle management, they are not verifying they’re collecting all the money they could.

At RCM360, we believe in getting paid what your practice is due. Whether it’s entering billing encounters that providers haven’t finished in a timely manner, or accounts receivable follow up. Over the years, RCM360 has worked with many clients on an AR analysis to determine how much, on average, we can collect for the current…

For those of you in the south…Who loves shopping at Publix!?  This is not a commercial.  They do this great marketing promotion:  BOGO.  You perceive that you are getting a great deal by buying the first at full retail price and getting the second for free.  We could get into the details of the pricing…

I have been driving in Florida for almost a year and a half now. I am amazed at how some of the drivers down here are still alive. There are the turtles and the hares, but what is the really concerning habit is the last minute 4 lane changers. This happens stopped at a stop…

For those FEW of you that read my blog for Mi7, don’t worry, these RCM360 blogs won’t be as technical. The blogs will, however, be just as witty and subject inappropriate as ever. I hope to bring some levity to your read while discussing some of the highest impacting topics related to the business of…