We are so pleased to have found TriZetto Provider Solutions and would highly recommend them. All of their service representatives are helpful and professional.
Jody Talbott, Ph.D. — Naples, Florida
Change is coming in payment models for physician practices. The repeal of the sustainable growth rate formula and replacing it with the merit based incentive payment system (MIPS) and the alternative payment models (APM) provide a fundamental shift for physician practices.
Just seven months remain before the new Medicare physician payment systems go into effect. On April 27, the federal government released the proposed final version of MIPS, one of the new systems. Here’s what you need to know now.
Let the old saying, “we all make mistakes,” be your guiding principal for monitoring the money coming in from third-party payers. As remittances are received from payers, your duty is to verify that the information is correct. Sounds like a simple task, but there are several crucial steps to achieving consistent success in recognizing and remediating less-than-expected – underprofile – payments.
Many practices are part of, or soon will be part of, Accountable Care Organizations (ACO) or other Alternative Payment Models (APM). These payment models will provide bonuses or penalties, based partially on the severity of the practice’s patient population. The payer uses diagnosis codes submitted on claims to determine this severity. Payments for individual physician services are based on CPT code, but now, accurately reporting co-morbidities and underlying medical conditions will affect reimbursement for physician practices.
Times are changing. A greater number of patients are covered by health insurance than ever before and many don’t understand their health plans. Patient financial responsibility has increased and practice revenue is now more dependent on patient payments. Learn how your practice can navigate skyrocketing patient financial responsibility in this recorded webinar hosted by TriZetto Provider Solutions and Betsy Nicoletti.
In February, the Centers for Medicare and Medicaid Services (CMS) released new rules regarding overpayments. Historically, overpayments – often referred to as “credits” in the business office – have been identified and addressed at the practice’s own volition. CMS’ Final Rule removes any latitude you may have relied upon in the past, requiring Medicare overpayments to be returned no later than 60 days after being identified.
We help physicians, hospitals and health systems simplify business processes and get accurate payments quickly. We will always look for new ways to help you improve revenue and increase cash flow. We will stay ahead of regulatory changes so your office will never struggle to keep up. All so you can focus on the one thing that really matters: doing what is best for your patients.
Patient AccessClaimsCollectionsDenial ManagementContract ManagementCustomer Care
One Financial Plaza
501 North Broadway
St. Louis, MO 63102