American Physician Financial Solutions

A new year!  Which brings many of the same old issues back to the table.  Below are some thoughts on how to navigate through January and beyond.   1.  Verify Patient Information – Some patients may have changes to their insurance plans.  Even if they are keeping the same insurance company, they may have changes […]

Once the December crush is over, you may want to consider having a friend or colleague pretend to be a new patient.  I call a lot of phlebology practices.  I am constantly struck by the difficulties I face in reaching someone.  As a potential new patient, if it is not easy, I am inclined to […]

Templates. They are a standard of practice, a requirement for your EHR, a time saver, and the bane of the medical reviewer’s existence.   Errors are common.  Designated templates are used from case to case.  This requires key elements of the form to be updated to match the specific case being documented. Common elements in […]

by Marcy and AJ Riviezzo   Every year the management of a practice becomes a bit more complicated, a bit more exasperating.  A physician owner has to balance staff, revenues, expenses, equipment, marketing, and competing in an ever crowded market while reimbursements continue to be flat.  Finding time to do a comprehensive internal practice review […]

by Rick Nielsen and AJ Riviezzo In working with a large number of different practices, one oddly common theme is a lack of HIPAA awareness and compliance. I routinely receive unsecured emails with the patient’s full name (sometimes with other PHI information). Occasionally the patient’s name is used as the header of the email. This […]

The Centers for Medicare and Medicaid Services (CMS) is moving towards decreasing reimbursement for complete diagnostic ultrasounds (93970) to the same level as a limited ultrasound (93971).  Currently they are in the process of grouping these two services in the same Ambulatory Payment Classification (APC).  If this happens ambulatory surgery centers, independent testing facilities and […]

One of the biggest concerns in a practice is their collections.  Getting patients in the door is only half the battle.  Having their claims processed to completion is the natural outcome, but at times this seems to be the portion that gets swept under the rug.   Day-to-day operations gets in the way of a […]

One of the larger frustrations over the past few years has been the increasing denial of the US guidance code (76942) when performing sclerotherapy.  A few large commercial payers, many small commercial payers and even one Medicare regional administrator will no longer pay for the guidance code stating it is either not medically necessary or […]

Some of the practices with whom I’ve worked had a similar statement.  The practice had received an authorization for services that was not being honored by the claims processing department.  There is actually a lot happening behind the scenes in that statement.  Here’s how this unpacks.   The authorization is simply a ‘mother may I’.  […]

In working claims for our billing clients, conducting audits as part of our consulting services, and in assisting practices going through a Medicare or commercial audit, we have noted a few trends that the payers focus on.  Below are some of the key and consistent elements we see in failing an audit.   Conservative Therapy […]