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5 Rules to Follow When You’re New to Medicare

5 Rules to Follow When You’re New to Medicare

There are many ways in which doctors can expand their practices, and Medicare is one of them. Medicare has the tendency to pay consistently and without delay, making it much easier for practices to grow.

Nevertheless, choosing to accept Medicare isn’t really a ‘one and done’ decision. Rather, it requires a thoughtful approach to ensure that practices are paid appropriately, maintain adequate cash flow, and secure profits, so auditors don’t attempt to recoup that loan eventually.

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This article provides 5 tips for practices that are new to Medicare:

1. Employ a nurse practitioner.

The cost-to-revenue ratio is considerably lower when non-physician specialists (NPP) treat Medicare patients. This suggests it’s ultimately more lucrative when NPPs see these patients. This method also permits doctors to fill their schedules with patients whose insurance pays more per relative value system. This enables the practice to deal with and accept Medicare clients without needing to drain pipes all of the doctor’s time and resources.

2. Balance your schedule.

For instance, set aside a particular variety of daily slots for patients with Medicare, Medicaid, and personal insurance. Because Medicare frequently pays the lowest, consider setting rigorous limitations for the variety of Medicare clients seen in a single day or week, states Cohen. Balancing the schedule in this way creates a cash flow balance.

3. Develop a compliance strategy.

The Office of Inspector General (OIG) supplies assistance for private and small group doctor practices to help them carry out internal tracking, carry out practice requirements, establish corrective action and more. Following a recorded compliance strategy assists physicians remain on track, and it alleviates risk for recoupments and rejections, says Cohen.

4. Work with your practice management supplier.

It’s challenging to implement this very same kind of checks and balances with personal payers, says Cohen. “The issue with personal payers is that there’s still a lot of black box editing that goes on,” he states, adding that he just recently had to look 22 pages deep into a payer’s website to discover its payment policy.

Due to the fact that Medicare’s National Coverage Determinations, Local Coverage Determinations, and National Correct Coding Initiative edits are entirely transparent, doctors are most effective when they work with their practice management vendors to ensure that these details are filled on the front end. This enables practices to verify claims prior to submission. Many systems likewise provide coding checks that confirm procedural codes and modifiers.

5. Hire an external auditor.

Under these self-disclosure and repayment policies, the federal government and personal payers are expecting doctors to employ an external auditor. External auditors can easily identify billing and compliance threat that could be possibly devastating when left unaddressed.

Choosing to accept Medicare can assist doctors to grow their practices, however, just when implementing a tactical approach to remain successful. This consists of a mindful factor to consider of staffing, scheduling, auditing and billing.

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