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

-
Image
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...
Post a Comment

MACRA/MIPS Reporting in 2017: What’s in Store for 2018?

-

 

macraandmipsreportingin2017whatsinstorefor2018.png

As physicians, doctors, healthcare units, ASCs, and medical billing and coding companies observe this year’s passage of the newly laid MACRA/MIPS reporting rule, there are a lot of dilemmas about its positives and avoidance for the year 2018. However, it will be important to notice whether the final rule continues to trend toward value-based care. Also, given the intricacy and sweeping nature of QPP, it is yet to be seen whether or not positives and avoidances will alleviate administrative burden.

Understanding the MACRA/MIPS Proposed Rule

Experts, including those working in the government, who are keenly observing the scenario, have some important takeaways from the proposed rule:

  1. Around 34%-36% of physicians will be eligible for MIPS after all exclusions, although they make up 55%-58% of Medicare Part B charges.

MACRA/QPP is an enormous piece of legislation. At its business end, it will eliminate the sustainable growth rate formula and replace it with a 0.5% annual rate increase throughout 2019, after which physicians will be or will be encouraged to shift to one of the two Quality Payment Programs:

  • Merit-Based Incentive Payment System (MIPS)
  •  Alternative Payment Model (APM).
  1. The proposed scenario for the 2018 rule includes the option for providers to band together in Virtual Groups.

If you remember, this option was not available in 2017. The situation with Virtual Groups is that they allow solo practitioners or physicians in groups of 10 or fewer to combine for MIPS participation virtually. To become a Virtual Group, a solo practitioner or group must combine with at least one more solo practitioner or group, regardless of location or specialty. Make sure you register before the 2018 performance year also solo physicians must be eligible for MIPS on their own.

  1. Hospital-based doctors can now report at a facility level as well

Hospital-based physicians in the year 2018 MIPS performance period will now have the opportunity to be evaluated on quality and cost, in the context of the facilities where they practice. Such physicians can submit their facility’s in-patient value-based score to help calculate an individual score.

Experts think that such a move could be a big win for administrative simplification, as before, there was no recognition or special category for doctors who work in facilities such as a hospital.

To learn more about MACRA/MIPS Reporting in 2017: What’s in Store for 2018?, click here: https://bit.ly/46J84vg, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

Is Your Neurology Billing Outsourcing Helping or Hurting You at Year-End?

-
Image
  As year-end approaches, neurology practices face a crucial decision: Is your billing outsourcing truly improving your financial performance, or silently affecting your revenue? Neurology billing is complex due to time-based coding, modifier usage, high documentation requirements, frequent audits, and prior authorization challenges. If your billing partner lacks neurology-specific expertise, it may lead to claim denials, revenue loss, and compliance risks. Signs Your Neurology Billing Outsourcing Is Helping If your billing partner is performing well, you will see: • Reduced denial rates for neurology codes (EEG, EMG, Botox, Nerve Conduction Studies) • Faster reimbursements and fewer delays from payers • Active recovery of old AR beyond 60, 90, or 120+ days • Accurate CPT, ICD-10, and modifier usage for neurology procedures • Clear billing reports, denial analysis, and revenue insights • Compliance with Medicare, commercial payers, and documentation standards Warning ...
Read more

How Hidden OB-GYN Billing Errors Are Quietly Costing You Millions Each Year

-
Image
  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...
Read more

Why High-Volume Primary Care Clinics Still Struggle with Cash Flow in 2026

-
Image
Patient volume alone does not guarantee financial success. Many high-volume primary care clinics are seeing more patients than ever in 2026, yet they continue to experience declining cash flow, increasing accounts receivable (AR), and inconsistent monthly collections. Despite busy schedules and full appointment books, reimbursement delays, payer denials, coding errors, and administrative inefficiencies often prevent practices from converting clinical activity into predictable revenue. Today's primary care environment is more complex than ever. Evaluation and Management (E/M) coding updates, Medicare Advantage policies, commercial payer requirements, prior authorization rules, and preventive care reimbursement all contribute to a challenging revenue cycle. This is why many providers are asking: Why do high-volume primary care clinics still struggle with cash flow in 2026? The answer often lies within the billing process. Practices that invest in specialized Primary Care Billing Ser...
Read more