The New Year is a new opportunity to start fresh. We use a very important concept called "self-efficacy" when we make New Year's Resolutions. This means that we can set goals and follow through on them, giving us a sense of control over my life. New year, new business opportunities, new chances to grow. People in the business industry use this opportunity to create new habits that will help them in their business. Habits to maintain up to the end of the year.
In midwifery, particularly in billing for your practice, it is important to measure the habits you have, improve the old habits that helped your practice, and remove those habits that made your billing procedures difficult. It is possible to resolve and improve your medical billing process by setting aside some time. In a matter of days, this can make a huge difference in your bottom line. We recommend that you take the time to read these seven tips and find cash where it is missing. What are the best ways you can improve your billing for your midwifery practice?
1. Collect patient contact information and insurance details prior to their appointment
It will save both you and your client a lot of time by collecting the necessary information before your clients visit the clinic. This will also allow you to plan the end of your day. Your receptionist/front desk staff should be able to collect the most current and complete information from patients calling your office to schedule an appointment. Patients can also choose to send or mail their information. This information should be available on your patient portal and online appointment tool. Staff will be able to verify the patient's insurance information and follow-up with them throughout treatment and collection.
2 Check your client's eligibility for insurance and calculate any outstanding balances
Verify coverage with payers before or during service. These steps will allow you to identify any changes in patient collections, determine what percentage of the treatment will be covered and who is responsible for payment.
3. Adopt a payment policy that places patient responsibility at check in
Patients should be required to pay copays at check-in. This is the best way to collect patient balances. Create a policy for medical offices to ensure that patients are aware of the requirement. Include a patient responsibility agreement for patients to sign in your check-in paperwork. This policy provides clear guidelines to your staff and patients regarding collection. You can also use your patient message solution for automated appointment reminders that communicate what is due at the time you are providing service.
4. Transparency in your billing and collection processes
Patients should be aware of your terms and conditions for medical billing and collection. They won't be surprised if a bill arrives and they don't know what to do. Transparency in billing can help reduce the stress for both your staff and your patients. You can also help your patients by keeping all their current information on file, so that claims are correctly submitted and not denied.
5. Accept multiple payment methods
You can increase your chances of getting balances collected at check-in by offering multiple payment options, such as cash, credit/debit cards, and checks. A convenient and simple-to-use online payment system can be included in your patient portal. This will facilitate patient payments.
6. Provide payment plans and keep track of them
Establish payment plans to help with larger balances. Train staff how to explain and track these options. Your practice will increase its collections by offering flexible payment options. Patients will feel more secure knowing that they can afford the treatment they require.
7. Monitor unpaid accounts
To maximize collections, persistence is the key. Create a plan to contact patients who have not paid on time and a protocol for staff. Your staff should be able to request payment in full, discuss payment options and offer a plan of payment if necessary. You should track accounts at all stages of your revenue cycle. Also, pay attention to unpaid accounts. These accounts can often lead to problems or unresolved billing. A tracking system should be in place to track every account's status. It can tag any status as unpaid, pending or paid. You can also manage tricky accounts by keeping a list of problem accounts that you check on regularly.
8. Learn how to bill Medicare or Medicaid and how to train your staff regularly
Every week brings new medical billing issues. It is important to keep your staff trained and current on how to bill Medicare, Medicaid, and your insurance partners. It will save you time and money on corrections and resubmissions. It is easy to improve your medical billing process by hiring professionals to visit your practice and learn about your accounts receivables and then implement a better billing strategy. The most trivial part of having a new year’s resolution is it may only happen for three months after the new year itself. Many people fail because they lack consistency and motivation to push through. Remember, when you start something, always make sure to finish it.
6 tips to improve collections and cash flow at your medical practice. Greenway Health. (2020, June 22). Retrieved November 28, 2022, from https://www.greenwayhealth.com/knowledge-center/greenway-blog/6-tips-improve-collections-and-cash-flow-your-medical-practice
Marketing, P. (2021, April 26). 4 ways to improve your medical billing process - frost-Arnett. Frost. Retrieved November 23, 2022, from https://www.frost-arnett.com/4-ways-to-improve-your-medical-billing-process/
Regulation Changes for Billing in 2023
Regulatory compliance helps you protect your business's resources and reputation. Building trust with prospects, customers, and vendors takes time. A large part of that depends on your ethical conduct. Compliance is the foundation upon which your company's reputation can be built. For those who work in the midwifery industry, the sheer number of regulations that regulate maternity care can be overwhelming. Nearly every aspect of this is monitored by one or more regulatory bodies. Some midwives feel they spend more time following rules than actually performing the work.
Billing is a complicated part of your midwifery practice because its system is designed to allow for payment by insurance companies or government programs like Medicare and Medicaid. These payers require that bills be submitted using specific diagnosis, treatment, and supply codes. Otherwise, the bills will not get paid. That is why you need to be aware of any changes in billing regulations, regardless of whether you bill for your own practice or hire someone. New billing regulations have been published since the end of the year. These are the new billing regulations that every customer and biller must know about for 2023.
The existing 2021 guidelines implemented by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) allow healthcare providers to document E/M visits based on medical decision-making (MDM) or total time. This was a major departure from the previous guidelines that required them to address three elements in the patient’s progress notes: patient history, physical exam and medical decision making for code selection). The new E/M guidelines for 2023 build on the flexibilities of the 2021 office/outpatient E/M coding and documentation rules.
2023 E/M Code Updates Reduce Documentation Burden
The goal of the updated guidelines for coding and documenting E/M services is to make coding and documenting E/M services easier for medical practices and other facilities.
The final CY 2023 PFS conversion factor is $33.06, a 4.48 percent decrease from CY 2022 and slightly higher than proposed. This decline is due to a statutorily required budget neutrality adjustment, an expiring temporary adjustment to mitigate the impact of previous coding changes and a zero percent update factor.
CMS finalized several significant payment policy changes, including revaluing remaining evaluation and management codes, continuing its four-year phase-in of clinical labor pricing updates, and delaying changes to redefine the substantive portion of a split/shared visit by time only until 2024.
CMS issues 2023 Medicare physician fee schedule final rule: Insights. Holland & Knight. (n.d.). Retrieved November 28, 2022, from https://www.hklaw.com/en/insights/publications/2022/11/cms-issues-2023-medicare-physician-fee-schedule-final-rule
What are the latest medical billing and coding changes in 2022? Outsource Strategies International. (2022, November 7). Retrieved November 28, 2022, from https://www.outsourcestrategies.com/blog/what-are-latest-medical-billing-and-coding-changes-in-2022/
A private midwifery practice 's success is not determined only by the quality of patients care, but it also includes your financial stability. However, they often have little or no experience in handling the financial aspects of a business. But finances are something that cannot be ignored. Many practices have fallen prey to financial ruin. One reason is that health care professionals often write off patient debts out of compassion. It is important to understand that deductibles may be deemed insurance fraud if they are not written off.
Private midwifery practices are no different. Every midwife depends on stable revenue sources. In the past, there was no such thing as a steady revenue source. Revenue from your midwifery practice mostly relies on cash flow and insurance reimbursements. This revenue responsibility shifts more towards consumers. Midwives choose to write off more 75% patient balances. This can have a severe impact on practice income. You can increase your practice's revenue by making sure your balances are clear of any overdue bills and by not writing off any deductibles or out-of-pocket expenses.
How can your practice address patient balance collection issues?
Importance of timely collection of patient balances on practice financials. Practolytics. (2022, January 27). Retrieved November 29, 2022, from https://practolytics.com/blog/importance-of-timely-collection-of-patient-balances/
s a midwifery practice owner, you must decide whether or not you'll accept insurance for healthcare or if you would like that your service be cash-based which means that the client pays on their own and at a predetermined fee for each appointment. There are advantages and disadvantages to accepting both forms of payment therefore your final decision will depend on the goals you have to achieve for the practice. There is no law which says that if you start with healthcare insurance, it is not possible to switch to cash-based services later on. date.
Most hospital-based midwifery services accept insurance. Nearly half of birth center practice accepts insurance. A smaller percentage of home birth clinics provide insurance processing. Families usually have to provide an insurance coverage with an itemized bills of service for reimbursement directly if out of network benefits are available.
Insurance plans with fewer benefits do not have out-of-network benefits, and being part of the network typically requires some type of malpractice insurance. Smaller midwifery practices may not be able to manage the monthly payments needed for that protection. The more extensive your practice or is expected to become more likely that to be insured and billing for services be essential to ensure that your business is profitable.
The choice between cash payment and billing insurance policies has numerous pros and cons every midwife should consider. Billing insurance plans do not just ensure that midwives receive the right amount of money, it also leaves a variety of benefits to the healthcare industry.
Functions of Healthcare Insurance and why Midwives Should opt to Billing Insurance Plans
In 2017, the average insurance premium for US families with employer-sponsored health insurance cost $18 764, an increase of 3% over the previous year. What this mean value hides, however, is the enormous variance in the amount of health care received by different people in the United States.
That variance is reflected in huge disparities in health care spending. In 2016, the top 5% of US health spenders accounted for 50% of total spending, or about $50 000 per person. The bottom half of the population, based on health expenditures, accounted for only 3% of total health spending, or $276 per person in 2016. People in both groups buy health insurance, but the benefits they gain from doing so are different.
In addition to helping people stay healthy and improving their health when they get sick, our system of health insurance serves at least several functions to enable everyone to benefit from being insured. These functions, however, are not always compatible.
Some of the benefits of outsourced medical billing include:
There is no certain reason for you to choose between choosing cash payments or billing insurance policies for your practice than knowing what you truly need. You need to look at your specific mission, goals, area, and services wanting to provide to the community. Typically, care is a hybrid between insurance reimbursement and cash discount prepayment models of payment. It will give families choices that can fit a family that doesn’t have good and poor health insurance coverage.
Midwiferybusinessconsultation. (2020, December 11). Cash versus billing insurance for midwifery care? MIDWIFERY BUSINESS CONSULTATION. Retrieved September 30, 2022, from https://midwiferybusinessconsultation.com/cash-versus-billing-insurance-for-midwifery-care-2/
Hoffman, A. (2022, March 8). 6 proactive medical billing tips to maximize revenue: HAP. Healthcare Administrative Partners. Retrieved September 30, 2022, from https://www.hapusa.com/6-proactive-medical-billing-tips
Pranammya Dey, B. S. (2019, April 2). The 6 functions of health insurance. JAMA. Retrieved September 30, 2022, from https://jamanetwork.com/journals/jama/fullarticle/2729357
When we talk about matters pertaining to your client’s insurance, you have probably heard the terms “in-network” and “out-of-network” care thrown around quite a bit by different healthcare provider including midwives. But what do these terms actually mean, and more importantly what do they mean for you as a midwife? How will these affect your practice and you be able to apply these terms to your midwifery practice?
What does in-network mean?
In-network refers to a midwives that has direct contract with the health insurance plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, clients pay a lower cost-sharing when they receive services from an in-network midwife.
What does out-of-network mean?
Out-of-network refers to midwives who does not have a contract with the health insurance plan. If a client use an out-of-network provider, health care services could cost more since midwives don’t have a pre-negotiated rate with the client’s health plan. Or, depending on the health plan, the health care services may not be covered at all.
Depending on the coverage the client have purchased, the plan has established deals with a wide range of midwives and other specialists. These are the health care providers that the insurance company considers in your client’s “network.” The insurer has identified a group of providers who are “in-network” and has contracted with these providers on the client’s behalf to get services at “discounted” rates. The primary advantage of using an in-network provider is that your client receive this negotiated or discounted rate for your services, and the insurance provider generally picks up a larger portion of the bill than with an out-of-network provider.
This means that as a midwife, once you’re in an agreement with the insurance company to accept your client’s plans and contracted rate as payment for your full services. This contracted rate that was negotiated by your client and its insurance company includes both the insurer’s share of the cost, and the part that your client will be responsible for paying. The part that your client’s responsibility for paying may be in the form of a co-payment, co-insurance or deductible depending on their negotiation.
Simply speaking, as a midwife, when you accepts your client’s health insurance plan we say you’re in network. You will also be called as “participating providers”. When you don’t take your client’s plan, we say you’re out of network. The two main differences between them are cost and whether the plan helps you receive enough value for the care you provide as out-of-network provider.
Healthcare is an important aspect aspects of our daily lives. As a healthcare provider, we are expected to give the best services to our clients and in order for our practice to keep on growing we must receive proper compensation out of that service. Remind your clients that they can avoid unexpected medical bills by knowing how their plan works. Certain choices they make can affect what they'll pay out-of-pocket. Know the difference between in-network and out-of-network care to help them save on health care expenses.
Outreach & Education. CMS.gov Centers for Medicare & Medicaid Services Health Insurance. (n.d.). Retrieved May 13, 2022, from https://marketplace.cms.gov/outreach-and-education