Accounting Services for Medical Practices - An Overview

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Accounting Services for Medical Practices - An Overview

Businesses need a solid accounting system and cash controls to succeed. While medical practices differ from traditional businesses in many ways, a practice with unbalanced books or without an eye on its books at all, will fail.

For many practice owners, accounting can be an enormous hassle. Generating financial reports and balancing books detracts time and money from medical services. Why should aging receivables and late payments prevent you from providing quality patient care?

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How to Be a Good Practice Manager in 8 Steps

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How to Be a Good Practice Manager in 8 Steps

A medical practice needs more than just doctors to function at a high level — it’s more than just a patient treatment facility…it’s a small business and a community, with all the associated complexities. It needs strategic vision, a business plan, a guiding hand, a day to day leader and a right hand to the physican. Without a good practice manager, a medical office risks reduced patient care quality, reduced revenue, reduced office culture, or even practice closure.

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Auctus Summer Meeting 6/21-6/22

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Auctus Summer Meeting 6/21-6/22

We are so pleased to share a look into our first ever all company outing!

Not only is our group full of incredible and unique people; but seeing us all together in one place was one of the more proud moments of the company thus far. 

So, let’s begin!

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The Best Dermatology Billing Software Programs

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The Best Dermatology Billing Software Programs

With many medical billing softwares on the market, it is difficult to select the right one. There are numerous options to consider. Do you want a comprehensive package? Or just revenue management? Do you need iPad compatible software? Or just desktop? Lastly, do you want general software or one for your medical specialty?

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6 Benefits of Medical Billing Outsourcing

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6 Benefits of Medical Billing Outsourcing

Medical billing is a complicated affair. Claims must be filled out completely, correctly, and on-time. There are thousands of different claim codes for each medical sub-section, and hundreds of reasons for claim denial.

The process is time-consuming. With the burdens of running your own practice, billing can become overwhelming.

When it comes to getting help, you’ve got 3 options: hire an in-house biller, assign billing to your front office, or outsource your billing.

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ADM Reconstruction Medical Policy Changes - Dermacell

Big changes to Acellular Dermal Matrix (ADM) Medical Policies!

As an aside - we are not affiliated with, making any recommendations regarding, or suggesting superiority of brands in any way.

For a long time, Alloderm has been the only allowed ADM.  Other venders and brands have been considered "experimental."  Dermacell, another prevalent brand in the marketplace, has recently broken through the med pol end here and gotten approved as medically necessary with the majority of the major payers.

Why does this matter?

Many providers often use non-approved or "experimental" brands in surgery.  These brands may be equivalent or beyond in terms of real world efficacy, but medical policy updates move slow.  If a surgeon utilizes an "experimental" substance, it may be paid because the reviewers don't catch it or don't even ask for records.  The risk here is massive.  Hospitals are often unforgiving in their billing of patients and that is exactly where the bill tends to land so be careful!

What if the brand I like isn't approved?

Our stock response is don't risk it without backing from the vender to cover the cost.  The medical policy being dated or wrong isn't going to change things.  Feel free to work with the vender on pushing for approval if you would like to help, but until the substance is approved, don't risk it.

We have a few other tips and tricks too so feel free to reach out for further info!  Feel free to call me directly! 

 

John Gwin

Founding Partner

708.669.9313

jgwin@theauctusgroup.net

 

Which insurance companies are covering Dermacell?

Aetna – Medical Policy: Breast Reconstructive Surgery, Policy # 0185: http://www.aetna.com/cpb/medical/data/100_199/0185.html

Cigna – Medical Coverage Policy: Breast Reconstruction Following Mastectomy and Lumpectomy, Policy # 0178: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0178_coveragepositioncriteria_breast_reconstruction_follow_mast_lump.pdf

UnitedHealthcare – Medical Policy: Breast Reconstruction Post Mastectomy, Policy #CDG.003.09: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/breast-reconstruction-post-mastectomy.pdf

Anthem – Medical Policy: Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting. Policy # SURG.00011:https://www.anthem.com/medicalpolicies/policies/mp_pw_a053309.htm

Press Releases:

LifeNet Health Press Release regarding Dermacell coverage, Anthem: https://www.prnewswire.com/news-releases/lifenet-healths-dermacell-acellular-dermal-matrix-receives-anthem-coverage-300603527.html

LifeNet Health Press Release regarding Dermacell coverage, Cigna: http://www.prnewswire.com/news-releases/dermacell-receives-coverage-from-cigna-300411026.html

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Modifier 25 Reduction for Same Day Services Rolled Back

A very significant step in the pushback against the trend of slicing into physician revenue by insurance carriers was taken this month as Anthem rescinded its January 1, 2018 policy for same day services.  Previously the policy intended to reduce E/M reimbursement by 50% when rendered on the same day as qualifying procedures.  After a push by physicians, this policy has been rolled back to March 1, 2018 and from 50% to 25%.  Continued efforts by physicians and the AMA will hopefully put a complete stop to the policy altogether, but that is left to be seen.

AMA Article link below here...

https://wire.ama-assn.org/practice-management/win-doctors-anthem-rescinds-pay-cut-same-day-services

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BCBS IL Pre-Auth Changes for 2018

Some pretty major changes to pre-auth requirements for BCBSIL.  This means that authorization staff will have to submit every time for approval.  Please keep in mind how this will impact booking timelines.

 

Notable changes:

 

19318 - Breast Reduction - Best practice has been to submit for pre-determination regardless so not a massive impact here.

 

211XX - CMF - Many craniomaxillofacial midface reconstruction codes now require authorization, which will be a bit of a change.  Given most of these cases may be rendered in emergency situations, hopefully not a huge process change for most of us.

 

30520 - Septoplasy - probably the most notable change as no review was previously required.  This will push back booking time frames for septorhinos.  For those practices booking prior to obtaining authorization please be sure to keep a close eye on this change.

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