In the upcoming year, healthcare providers will face increased scrutiny of their coding practices as well as the continued reduction of reimbursement from Medicare and other third-party payers. Many practices are already experiencing problems in these areas, including management of reimbursement denials due to late filing and/or duplication of services, and increased expense relating to supporting medical necessity and correct medical coding.
etHIN provides approved physicians and their support staff access to information that is needed to help reduce or prevent payment denials. etHIN’s clinical portal, the Virtual Health Record (VHR), frequently includes patient insurance information, which can make determining the proper plan with which to file a claim much easier. Providers can quickly determine if a patient has Medicare or a Medicare replacement plan, which allows for billing within the approved timeframe, making reimbursement much more likely.
Medicare guidelines are becoming more rigid with regard to how often imaging studies may be performed and how many times a procedure may be updated due to a certain indication. etHIN provides authorized users access to image reports and their associated studies from numerous hospital systems. From this information, authorized users can determine if, and when, studies for a specific problem were performed elsewhere. This additional information can help the provider make decisions about whether another or perhaps more complex study is needed, and whether or not it would be reimbursable.
The need to substantiate medical necessity continues to be a major determination of payment for those services rendered to the patient. Within the etHIN VHR, authorized users have access to the patient’s previous ICD-9 codes (both acute and chronic) as well as studies that have been performed, medications previously prescribed, and a long-term picture of the patient’s health status. This information provides the documentation to support the medical necessity of the physician’s decisions, thus affecting your bottom line.
There are numerous ways that the information accessible through etHIN can be beneficial to your reimbursement. Some other examples include determining the appropriate modifier for your patient’s health status or the presence of patient or family history to which you otherwise might not have had access. Use of available patient information within etHIN may reduce and potentially prevent decreased revenue for your practice, which could result in negative business impacts such as reduced support staff, limitations on supplies and equipment, and shrinking physician compensation and bonuses.
What are your challenges for the upcoming year? Give etHIN a call at 865-691-8433 to learn how we can help.