Today the most optimistic outlook is a reduction in that loss to only $53 billion for 2021. At least one report indicates that among the top causes is a marked drop in elective procedures:

• Cardiac procedures down 50 percent
• Cardiac elective surgeries down 65 percent

Learn strategies on how to mitigate and manage the impact of those losses here.

Communicate With Payers

With a decrease in elective procedures and an increase in losses as a result of Covid, maintaining relationships with payers has never been more important. Hospital management needs to ensure the lines of communications between key stakeholders and payers stay open and consistent. This can be streamlined:

• Discuss challenges with payers in real-time
• Implement a clear contract management system with relaxed negotiations
• Track administrative problems and offer transparent solutions to payers
• Monitor flow of all communication
• Utilize variance reports internally when non-payment from the payer occurs

It may be that you still aren’t recovering reimbursement losses even with the most efficient communication system internally and externally. You may just not know exactly where the losses are.

Track Your Payers

Your organization may benefit from tracking payers.  You can do this by comparing which payers are the most efficient for your hospital. Volume metrics are important here. So are metrics pertaining to the accuracy of reimbursements. You may be experiencing significant losses that just aren’t being caught.

Create a metrics system to analyze how payers contrast with each other. Where are you seeing the most denials?

Create reports that indicate areas of key losses. Tracking payers will enable you to identify where the most losses are occurring, even at the patient level.

Consider Value-Based Care

Depending on elective procedures as bread and butter revenue is a fee-for-service model. It is not the most secure model in health care now, because that revenue just isn’t there anymore. It has been cut by at least half to prioritize a greater health care need, and to prioritize quality care in a different area of health care. Transitioning to a value-based care system may be the clearest answer to the question, “what will health care look like after Covid?”

A value-based-care system considers reimbursement from a quality of care perspective. Here, accountability is key. The additional focus is on value-based care – good outcomes for patients. In this model, the hospital does not have to depend on how many hip replacements will be happening that month.

Instead, the performance metrics of the service providers themselves will be measured. When a physician can treat a patient in fewer visits than a fee-for-service model provides for, everybody wins.

In this scenario, health care administrators can effectively examine where costs need to be cut, without compromising level of service. In theory, it works. In practice, it works as well when administrators focus on contracts with payers that are operationally prepared for this model.

Health care organizations today do not find this to be the most lucrative model, and may be resistant to it. Some actually do want to profit from every Band-Aid. However, in this era, that mindset may need to be temporarily archived when board agendas contain keywords such as “hospital bankruptcy protection.”

Inflation is rising. Demand on hospital supplies and labor resources is tapping out everybody. Before Covid, hospital gowns for example cost 22 cents. Today, $10 each.

Rethink Revenue and Reimbursement Losses

Hospitals face financial challenges of historic proportions with historic implications, with inflation on the rise. Health care managers now face the task of managing the impact of those losses as elective procedures hit the pause button. The fee-for-service model isn’t feasible, or even as readily available, at this time.

Today’s boards face the issues of fewer staff, more expensive supplies, and a cycle of reimbursement losses that seems never-ending. What will health care look like after Covid? Boards and reimbursement managers might have tougher times managing the impact of revenue losses.

A value-based-care system can solve many of these problems. So can rethinking communication strategies with payers, and tracking them and their metrics more effectively. Contact us for more information and guides on how to improve revenue models in your own healthcare system. Check out our free assessment pages to learn more about how you can help your own organization.

The post How to Manage the Impact of Revenue and Reimbursement Losses as Elective Procedures Drop appeared first on The Midland Group.

Why is Technology Taking Over?

All health care workers today must be both clinically experienced and tech-savvy. With the ongoing challenges in recruitment and retention, it’s essential for doctors to develop the right balance between adequate workflow and technology. Otherwise, an imbalance can potentially lead to dissatisfaction. It’s not easy to achieve this noble goal, and it may actually mean additional training and support as everyone keeps up with the process.

Notably, X-ray, lab, and pharmacy systems are not interoperable, and physicians are under obligation to enter every information into the medical record to address administrative and billing requirements. All this data entry means doctors have very little time to connect with their patients and address their needs. Studies by the American Journal of Emergency Medicine have found that doctors spend only 28 percent of their time on patients and 48 percent on data entry.

How to Create an Appropriate Balance?

The entire idea of incorporating tech in health facilities is to improve patient care. Every patient walks into a health institution hoping to get the best form of treatment technology could offer. Unfortunately, doctors spend more time on computers than physically talking to their patients, which significantly impacts health and wellness outcomes.

On the positive side, patients feel that technology makes processes faster, smoother, and more efficient. They also feel that their records are safer in data systems than on traditional hard copy files. The quick access to medical records helps ensure that patients are not misdiagnosed or given the wrong treatment. While this is good news, doctors still need to spend quality time with their patients. Developing quality communication and building doctor-to-patient relationships creates trust, and patients feel appreciated and respected.

It’s clear that technology is here to stay, and it will significantly benefit the health industry. Medical professionals will still need to juggle data entry and find ample time for their patients. It all comes down to timing.  Doctors can allocate specific time for patient interaction and give time for data entry. Entering data later in the day may not be effective. Instead, they can use the first few minutes entering data such as the symptoms and use the last few minutes for communication.

How Health Professionals Can Provide Proper Patient Care

Communication is a very powerful tool when used appropriately. It can be delivered in facial expressions and other non-verbal cues to convey different messages. Doctors often sympathize with their patients but may not always show this when they’re busy typing and entering data. This kind of attention is quite essential for sensitive and vulnerable patients with severe illnesses or those dealing with emotional or physical losses. Therapeutic touch and effective communication create a sense of security, and it may increase a patient’s confidence when feeling isolated, fearful, and lonely in an unfamiliar environment. Doctors should learn to:

• Give their full attention to their patients
• Listen, smile, lean forwards, or even nod or shake their heads gently to show interest.
• Make eye contact to convey respect and understanding
• Touch or place a hand on a patients’ shoulder to show care
• Consider hearing and visual limitations when interacting with patients.

Has technology contributed to faster patient care? Absolutely. That means more time can be created for patient interaction through proper scheduling.  Both doctors and patients greatly benefit from the efficiencies in the systems, which are constantly improved to provide even better health care.

For instance, a doctor doesn’t need to move from their office or send a patient to the lab or pharmacy with a piece of paper because they can communicate virtually with any medical professional in that hospital from their computers. Technology has also made billing--one of the most complex and critical areas of a health care system–more effective and accurate.

Need Help?

At Midland Group, we care about what you care, and that’s why we go out of our way to help you with your insurance claims. Our dedicated team of professionals is trained to handle tools, documents, and rules to submit a proper insurance claim. Feel free to call and schedule an appointment with us.

The post How to Balance Technology and Patient Care appeared first on The Midland Group.

First, let’s talk about why claim denials occur. This can happen for a variety of reasons. Perhaps there is not enough information in the form to make a decision from the insurance company’s perspective. The information provided may not match the client’s previous information. Perhaps there was an address change or other demographic information has changed since they applied for the insurance. Whatever the case, get the paperwork right first. Then we’ll talk about the other reasons you might be denied and how to avoid denials.

How Do I Avoid Having My Claim Denied?

There are a number of reasons claims might be denied besides having the wrong forms or having information that is outdated or irrelevant.  It is important that you understand the reasons so that you can present your claim in such a way that the insurance companies know it is a valid claim.

5 Tips to Help Avoid Denials

Here are some tips to remember to avoid denials when you file patient insurance paperwork:

1. Verify eligibility. It is important that you check to make sure your patient qualifies for the insurance in the first place to avoid it being automatically thrown back to underwriting or tossed out as an unqualified claim. Make sure the patient is covered for the medical condition that you are applying for on their behalf and get any questions answered at the onset to avoid service and payout delays.

2. Be specific about the medical condition. Insurance operates on a very specific assumption: that you are covering the exact illness or medical condition and under the circumstances that are covered by the insurance. Be sure this is accurate before starting a claim.

3. Be prompt. There’s nothing worse than missing a deadline. This is especially critical with insurance claims. The insurance claims are so specific that, by law, if you are even 1 minute past the deadline,  you are not covered and the policy will be invalidated.

4. Learn from former denials. If your claim was denied in the past, find out why it was initially denied and learn from that. Call the insurance company or do your own side research to determine the reason, then make notes so that you will not make this mistake in the future.

5. Talk to experts. When you are unsure of how to answer a company form for an insurance or billing claim, ask an expert with more experience so that you will get it right. You simply don’t have time to waste when your client is needing help with an insurance claim. Do your homework and visit with an insurance or medical billing specialist.

Where We Come In

When talking about insurance claim experts, that’s where we come in.

We cover a number of different services and solutions that allow you to streamline your insurance systems and administrative tasks so that you have fewer denials and more successful claims for your patients. That’s what will keep your customers coming back time and time again.

By decreasing the number of denials you get from insurance claims, you automatically increase your revenue by establishing a system that works and that your most valued customers can rely on. That helps improve your reputation in business and in your practice, as well as ensuring you are providing your patients with the help they need when they need it most.

Contact Us

For help regarding your medical billing services, contact us online or call 785-330-7288.

If you’re wondering what you can do to increase your bottom line, look at your billing system first. Is it working the way it should work for your practice? If not, the problem could be with your billing and insurance. Call us first and you will see that we put our money where our mouth is.

The post How to Prevent Claim Denials and Increase the Reputation of Your Practice appeared first on The Midland Group.

Inform Patients They Can Get Help

One of the key services that financial counselors offer is creating awareness. Not everyone is aware of patients’ financial counselors. Some patients have only heard of it, but they do not understand how they can benefit. It is the duty of a financial counselor to inform them of the help they can get. In addition to that, some may feel uncomfortable requesting help on their own. A financial counselor can help them get the assistance they need.

Determine Health Care Eligibility

Financial counselors help one determine if they are eligible for health coverage. For instance, for one to participate in Medicaid, they have to be from low-income families, children, pregnant women, and senior citizens. Therefore, a financial counselor will assess your situation and inform you if you are eligible. If you qualify, they also assist you in making an application. This makes it easy for healthcare providers as they do not have to turn away patients.

Educate Patients on Their Insurance Benefits

As much as people get health insurance, not all of them understand their benefits. That is where financial counselors come in. They offer help in the following ways:

• Inform patients about their benefits
• Educate them on the annual deductible that has been paid
• Explain to them the difference between copayment and coinsurance
• Inform them if there is any benefit cap
• Explain the total cost of the treatment they are about to undergo
• Inform them of their out-of-pocket expenses
• And tell them of the payment policy of the specific practice they are seeking treatment at.

Communicate With Insurance Companies and Payment

When one is sick in the hospital, they are concerned about how they will get better. However, one also has to make calls to the insurance company to ensure they are covered. This is where a patient financial counselor comes in. They act as a middle person between you and the insurance company. They will ensure that the amount to be paid by the company is settled and inform you if there is an out-of-pocket amount you need to pay.

Assess the Financial Needs of a Patient

A patient’s financial needs are not constant. Therefore, even as a financial counselor assesses the patient’s financial needs at the beginning of their treatment, they also have to do it regularly. That means scheduling meetings with patients and their family from time to time. For instance, there can be a change in the patient’s job status, insurance coverage, and other daily activities. With those changes, the patient’s payment plan has also been affected. Therefore, the counselor can help the patient come up with a better payment plan that suits the change.

Additionally, some patients assume that their treatment is based on their financial capability. This makes some patients reluctant to open up about their financial status. A financial counselor must establish trust with patients by communicating compassionately about payment policies and treatment plans.

Negotiate and Arrange Payment Plans

After a counselor has assessed the financial needs, they can help negotiate better deals for patients who are underinsured or in need. For instance, a counselor can work with a pharmaceutical firm with a patient assistance program that helps eligible individuals. They also work alongside pharmacy insurance programs, ensuring any prescribed medication is covered by one’s financial resources.

Having a financial counselor in your practice improves your patient’s experience in the hospital. You will enjoy increased revenue, and you do not need to have an uncomfortable discussion with patients about billing. If you are looking for financial counselor services for your practice, you can contact us at The Midland Group. We will help ensure you and your patients benefit from our services.

The post Top Ways Financial Counselors Help Patients Navigate Costly Care appeared first on The Midland Group.

1. Look Back on Previous Denials

Start categorizing and documenting all the data that you can about denials in general. The first step to stopping claim denials is understanding why you are being denied in the first place. Have your billing department set up a system to accomplish this so that you can refer to the tool to prevent them from happening in the future.

2. Specific Details

Claims are often denied due to generality, causing the insurance provider to interpret the claim themselves. Be specific by using a diagnosis code with the highest degree of specificity as possible. Make sure you complete provided information as much as you can so that your claim cannot be interpreted in a way from which the insurance company can benefit.

3. Always Verify First

One of the first things that you should do is obtain eligibility information before scheduling an appointment of any kind. Verification of insurance cuts down your number of claim denials right away because you can seek another reimbursement option before the patient has even received the care. This will not cause any extra waiting time for the patient because appointments are scheduled in advance anyways. Most authorizations come with a time window for which they are valid, so making sure that the appointment meets that timeframe is very important.

4. Timing Is Everything

If a claim is late, they are typically always denied immediately. If the hospital is extremely busy, it is easy to get backed up on denied claims. It is important to have proper safeguards in place so that claims are submitted on time. Multiple denials can be extremely hurtful, especially when expensive procedures have already taken place. The hospital should set up systems to verify that claims go out on time, and regularly monitor this process.

5. Seek Help

All hospitals and administrative departments deal with this daily. Claim denials are one of the most common lost income areas in a business, that’s why it’s so important to learn how to prevent claim denials. Working with an expert can help you identify and follow through with the process of submitting, processing, and collecting the claims. This will help you establish a system that will monitor exactly why denials are happening and ensure that they do not happen again in the future.

Now What?

As a third-party billing specialist, The Midland Group can help you with all of your claims. Our trained medical billing professionals are familiar with all the tools, rules, and documents needed to submit a successful insurance claim. Contact us today or book your free assessment to see how you can maximize all potential revenue surrounding all types of claims, including third-party liability.

The post How to Prevent Claim Denials appeared first on The Midland Group.

Not only that, healthcare reimbursements are also a struggle for other providers. In fact, there has been an increase in widespread coverage loss and uncompensated care that has put a strain on hospitals. With all the uncertainty of COVID-19, getting ahold of missing insurance dollars can be extremely challenging. Providers scramble to find ways to quickly determine each patient’s coverage to help minimize bad debt. Hospitals, pharmacists, and other healthcare providers simply cannot afford to continue to lose money when they should be focusing on how to prepare for health coverage after COVID-19.

Health Coverage After COVID-19

These days, there is a lot of pressure on patient intake. More and more patients are visiting facilities for elective services and vaccination programs. Hospitals and other facilities try to capture adequate insurance information as quickly as possible to minimize face-to-face contact during admissions and to avoid delays.

Patient collections and billing staff are extremely overwhelmed. They must do manual verifications but, unfortunately, those are difficult to complete when operating remotely or in a setting where individuals are socially distancing and patient information might be incomplete.

During COVID-19, telehealth became the popular new digital healthcare technology. However, it tends to be covered less by private insurers as compared to Medicare and Medicaid. Coverage checks should factor this in to avoid errors and wasted time and resources. Without being prepared for situations like this, providers will run into telehealth coverage issues including delays or denials.

Lastly, individuals are seeking new employment now that COVID-19 cases are slowly on the decline. Tracking healthcare coverage as patients start new jobs with health plans can be challenging. Further, Medicare is changing codes and protocols for coverage which can be confusing and time-consuming for providers. A third-party vendor like The Midland Group can help identify all coverage options and make sure the right bill goes to the right payer.

Now What?

As a third-party billing specialist, The Midland Group will submit, process, and follow-up on all insurance claims as necessary to collect as much revenue as possible for the hospital and to reduce the patient’s personal financial burden. Our trained medical billing professionals are familiar with all the tools and pertinent documents needed to submit a complete claim and successfully collect the amounts of money owed. 

We have a firm knowledge of all industry standards, clearinghouse procedures, and even the adjudication process. For hospitals, it is an opportunity to collect 100% of charges owed with greatly reduced administrative costs. Contact us to see how The Midland Group can help you maximize reimbursements over the next couple of months.

The post What Will Health Coverage and Reimbursement Look Like After COVID-19? appeared first on The Midland Group.

Third-party revenue cycle management companies can do just that. The Midland Group offers hospitals a wide range of revenue cycle services, including our proven patient-focused payment plans and bill tracking that works. While hospitals can certainly attempt to manage their own in-house payment plans, there are several benefits to outsourcing payment plans to third-party vendors.

Medical Billing In-House

If you are working with a small population of patients in your hospital, and see less than 500 claims per year, you may find that sticking with billing in-house may work just fine. You may also opt to stay in-house if you have the appropriate number of staff who are already knowledgeable and experienced with billing.

One disadvantage that you may run into if you stay with in-house billing is the expertise gap that exists if your knowledgeable billing staff quit unexpectedly. If you only have one or two individuals in your billing department and they both call in sick or have an emergency, your billing department slows down significantly until they can be back in the office.

Outsourcing to Third-Party Vendors

Whenever a hospital allows a third-party vendor to take over their billing department, they free up valuable resources. Third-party vendors can discuss with patients about setting up payment plans that are designed specifically for that patient. Third-party vendors will send multiple emails, calls, and regular mail to complete payment plans for the hospitals.

When outsourcing to third-party vendors, hospitals find that a specialized team of revenue cycle management experts can manage thousands of payment plans in a fraction of the time that it takes an in-house billing staff to do the same. In addition, outsourcing hospital payment plans means that the hospital will not have to hire as many billing staff, and the in-house billing department can focus on serving patients’ immediate needs.

It would be extremely smart for a company to utilize a third-party medical billing vendor if they experience high employee turnover. This is because all employees must be fully trained and understand HIPAA privacy regulations and the need to protect sensitive patient data. Training on such topics can take weeks or months until the employee is comfortable in that subject.

Another benefit of using a third-party vendor for medical billing is that it helps reduce the amounts of errors that occur. Whenever a mistake occurs in claims under in-house billing, it can take them longer to fix the mistake because billing staff typically juggle a multitude of tasks. As such, many hospitals choose to outsource payment plans to a specialized third-party billing company because they find it to be more efficient, have fewer mistakes, and be beneficial for their billing department.

Now What?

If your billing department does not have the ability or resources to reach out to all your patients, you may want to consider outsourcing to a revenue cycle management company. The Midland Group is a dedicated revenue cycle management team that provides clients with first-class patient advocacy and maximizes reimbursements. We combine the unique offering of being a proactive partner while delivering every solution in one call, early in the process. Contact us today to learn more about the services we provide to help improve your hospital’s revenue cycle.

The post In-House Vs. Outsourcing to Third-Party Vendors appeared first on The Midland Group.

What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996, providing the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs. HIPAA also reduces health care fraud and abuse. It mandates industry-wide standards for health care information on electronic billing and other processes. Lastly, it requires the protection and confidential handling of protected health information. 

Be Committed to HIPAA

Any third-party vendor that comes into contact with or creates PHI through the work that it undertakes on behalf of the covered entity is known as a business associate (BA). Before granting access to any level of personal health information (PHI) to a BA, both the hospital and the third-party vendor must enter into a contract, also known as a business associate agreement (BAA), that details commitments to HIPAA compliance and provides assurances relating to the safeguarding of PHI. If any facility or a third-party vendor fails to comply with this process, they can expect significant financial and reputational damage. 

If a third-party vendor is working with your hospital or health-related facility and is handling PHI, seek reassurance that they recognize and understand that they are a BA and therefore equally responsible for complying with HIPAA rules and regulations. It is important to understand that it is not enough for third-party vendors to simply state that they are HIPAA compliant. A request for evidence of their HIPAA compliance and administrative capabilities is recommended. In addition, ask them to review their HIPAA policies and procedures or conduct a risk assessment before committing to working together. 

It’s All About the Agreement

Hospitals and other health-related facilities should never disclose PHI to any third-party vendor unless a signed BAA exists between the parties. A third-party vendor that is HIPAA compliant will not hesitate to sign a BAA that outlines all the terms as required by HIPAA. 

Always be sure to take your time reading the contents and take notes of any additional terms and conditions that are present but not required by HIPAA. Additionally, if your vendor will need to disclose your facility’s PHI to a subcontractor, make sure your BAA requires them to obtain a sub-contractor BAA from their own vendors which include the same security and privacy requirements as exist in the original BAA. HIPAA obligations need to trickle all the way down from health facility to vendor to subcontractor to sub-subcontractor, and on and on,  to ensure true compliance.

Understand How Your Third-Party Vendor Protects and Stores PHI

It is extremely important to understand how your third-party vendor securely collects, stores, processes, and transfers PHI. By being proactive, hospitals and health-related facilities can avoid financial and reputational damage. 

At The Midland Group, we believe that keeping sensitive information confidential and accessible is of the utmost importance.  We continue to use great care in evaluating and selecting the best data security partners with which to work. When you choose to partner with The Midland Group for your services, you can rest assured knowing that your patients’ information is protected with the best data theft defense solution, complete with numerous security certifications. To learn more about The Midland Group’s data security system, click here. 

The post How to Make Sure Your Third-Party Vendor is HIPAA Compliant appeared first on The Midland Group.

If you are an Oklahoma resident between the age of 19 to 64 with incomes up to 138% of the federal poverty level, you may be eligible. The annual gross income cap is $17,796 for a single person or $36,588 for a family of four. 

There are an estimated 200,000 additional Oklahomans that can get coverage with the expansion, including many adult males who were previously often ineligible under the old rules. Not only will patients have improved health outcomes under this program, but provider groups, hospitals, physicians, and more will benefit as well. 

July 1st through September 30th, new enrollees may get SoonerCare benefits that are coordinated by the Oklahoma Health Care Authority. On October 1st, 2021, OHCA plans to provide four private companies to coordinate care on behalf of the State. This will be a managed care program called SoonerSelect. 

Benefits of Medicaid Expansion

Having Medicaid expansion results in multiple economic benefits. It is proven that individuals who have medical insurance are more likely to get access to different preventative care options. This is crucial because a lot of individuals will leave their illnesses untreated if they cannot afford the cost of treatment. Insured individuals are less likely to go to the emergency room for an illness that is not an emergency, which saves money for both hospitals and patients. In addition, Medicaid expansion increases healthcare access for adults without children, parents, and low-income adults who are able to work. 

Now What?

The Midland Group is a trusted patient advocacy firm. We have worked with different facilities across the country and have seen firsthand the incredible benefits that accompany Medicaid expansion: for the patients, hospitals, and states. Our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. With over 30 years of experience, our team stands by ready to assist our partner hospitals to qualify their patients for various public benefit programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. Contact us today for more information regarding how we can help you. 

The post Oklahoma Joins in Medicaid Expansion appeared first on The Midland Group.

I am from Lawrence Kansas and I have worked at Midland for about 11 months as a Public Benefit and Accident Recovery Specialist. I have two little sisters Peyton (12) and Ellie (10), and my hobbies outside of work include baseball, fishing, and golf.

Tell me how you first got involved with The Midland Group.

My mom, Libby, has been working at Midland for five and a half years. When I found out the Midland OneClaim team was hiring, I applied! I couldn’t wait to get started.

What has surprised you most about working with Midland?

I’ve been so impressed at how hard everyone works to provide benefits for the patients we work with. It is really special to be able to help someone who genuinely needs help in order to get the assistance they need.

What is your job title and how do you like being in this role?

My job title is Public Benefit and Accident Recovery Specialist. I really enjoy being in this role because I get to help people where it is most needed. I spend time screening self-pay patients and accident-related accounts.

What do you like most about your job? 

I enjoy the family environment that Midland has created and even carried over itno remote work. It really makes a difference in the way our team operates. And like I said, I really enjoy helping people – it’s so rewarding.

Can you share a few moments that were impactful to you? 

One time, a patient told me about the struggles they were going through in life – and it was a lot! The fact that I was able to get them applied for Medicaid and provide coverage for their bills that they otherwise couldn’t pay off, was incredibly impactful.

What is your biggest achievement to date – personal or professional?

I mentioned earlier that I love playing baseball. Well, I was able to come back to playing baseball 11 months after having Tommy John Surgery, whereas the normal recovery time is 12-14 months.

Tell me about some of the people you’ve met while working in your role?

Everyone that I have met while I’ve been employed at Midland has made me feel like I belong in my role. Everyone is incredibly respectful and really helped me get settled into my current role.

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