What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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Proposed Updates for Skilled Nursing Facility Quality Reporting Program (SNF QRP)

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 Proposed Updates for Skilled Nursing Facility Quality Reporting Program (SNF QRP)

On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities (SNF) for the year 2023. This SNF PPS (Skilled Nursing Facility Prospective Payment System) includes proposals for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Program (VBP) for FY 2023 and future years. This proposed rule CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for nursing homes on an annual basis. 

What is the SNF QRP?

The SNF QRP creates SNF quality reporting requirements, as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).  Every year, by October 1, CMS publishes the quality measures SNFs must report. The IMPACT Act requires the reporting of standardized patient assessment data with regard to quality measures and standardized patient assessment data elements. The Act requires the submission of data pertaining to quality measures, resource use, and other domains. In addition, the IMPACT Act requires assessment data to be standardized and interoperable to allow for the exchange of data among post-acute providers and other providers. The IMPACT Act intends to standardize post-acute care data to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning. If an SNF fails to submit the required quality data, the SNF will be subject to a two percentage (2%) point reduction in the Annual Payment Update (APU) for the applicable performance year.

To know more about Proposed Updates for the SNF QRP click here: http://bit.ly/3Zuoyn9 Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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