With rising operational costs, staffing shortages, and inflation squeezing margins, a healthy revenue cycle isn’t just a goal—it’s a necessity.

The longer a claim sits unpaid, the less likely you are to collect it.

But WHAT’S THE FIX?

How do you take control of your revenue cycle without draining resources or constantly battling insurance payers and patients?

Let’s go beyond the basics and get into real, actionable strategies that will make a difference— strategies that can help you reduce aging A/R, speed up collections, and protect your bottom line.

1. Track and Prioritize A/R Like a Pro

Many healthcare practices struggle with cash flow because they don’t have clear visibility into their A/R. If you’re not tracking your A/R aging report closely, you’re already at a disadvantage.

What’s the biggest mistake? Focusing only on new claims while letting older ones pile up. The older a claim gets, the less likely you are to collect it.

How to Fix This:

Review your A/R aging report weekly: Know exactly how much money is tied up in unpaid claims and patient balances.

Set a threshold for action: Example: If a claim is unpaid after 30 days, initiate follow-up. Don’t wait until it’s 60 or 90 days overdue.

Prioritize high-value claims: Focus on larger outstanding balances first. A $5,000 claim stuck in A/R for 90 days is more urgent than five $100 claims.

Why Does This Work?

A proactive approach to A/R tracking prevents claims from getting lost in the system and increases the chances of collecting payments before they turn into bad debt.

2. Get Tough on Insurance Follow-Ups

Insurance companies delay payments on purpose—it’s part of their game. They know that if they slow the process down long enough, many providers will simply give up.

That’s why aggressive follow-ups are key. You cannot afford to wait for insurance companies to pay at their own pace.

How to Fix This:

Follow up at 30 days, not 60 or 90: If an insurance claim hasn’t been paid within 30 days, pick up the phone and call the payer.

Use electronic claims tracking: Many RCM systems let you check claim status in real-time. If you see a delay, take action immediately.

Escalate quickly: If a claim is stuck, don’t waste time with front-line reps. Ask to speak with a supervisor or use payer escalation channels.

When you show insurers that you won’t back down, they’re less likely to delay payments. Fast follow-ups = faster reimbursements.

3. Get Patients to Pay Faster—Without the Friction

More patients than ever owe a larger portion of their medical bills out of pocket. The problem? Many don’t pay on time—or at all.

Why? Because medical bills are confusing, unexpected, and often difficult to pay.

How to Fix This:

Offer online and mobile payments: Patients expect digital payment options. If you’re still relying on paper bills and mailed checks, you’re losing money. Utilize digital payments options  such as GreenPay Station to streamline payment processes.

Be transparent about costs: Surprise bills lead to unpaid bills. Give patients an estimate before treatment and discuss payment options upfront.

Set up payment plans: Not all patients can pay in full immediately. Offering flexible payment plans makes it easier for them to stay on track.

Automate reminders: A simple text or email reminder increases the chances of timely payment by over 30%.

Why Does This Work?

Patients don’t avoid paying because they want to. They avoid paying because it’s complicated. Make it easy, and you’ll see better collections.

4. Resubmit Denied Claims Immediately

Most denied claims are recoverable—but many providers don’t appeal them. Whether it’s a coding issue, missing information, or a payer error, the key is to act fast.

How to Fix?

Analyze denials weekly: Don’t wait until the end of the month. Review denials every week and categorize them by reason.

Fix and resubmit ASAP: The sooner you fix and resubmit a denied claim, the better your chances of getting paid.

Identify recurring issues: If a certain payer keeps denying claims for the same reason, it’s time to investigate and fix the root cause.

Denials don’t have to be permanent losses. With a strong resubmission process, you can recover a significant portion of previously denied claims.

5. Know When to Bring in Reinforcements

Sometimes, despite your best efforts, A/R still spirals out of control. If you’re dealing with 90+ day aging claims, overwhelmed staff, or a growing backlog, outsourcing may be the smartest move.

Here’s the Fix:

Assess your A/R situation: If more than 20-25% of your A/R is 90+ days old, it’s time to get help.

Work with an expert medical billing company: A dedicated A/R recovery team can reduce your backlog, speed up collections, and improve your overall revenue cycle.

Outsource strategically: DON’T outsource everything. It’s good to start with just aging A/R collections while keeping new claims in-house.

A good Revenue cycle management partner can recover revenue that your team doesn’t have the time or bandwidth to chase down. It’s an investment that pays for itself by bringing in money that might otherwise be lost.

Final Thought

Managing A/R isn’t just about billing and collections. It’s about making sure your practice gets paid for the care you provide.

• If insurance delays are the problem, tighten your follow-ups.

• If patient collections are slow, make payments easier.

• If denials are dragging you down, fix and resubmit claims faster.

• If aging A/R is piling up, consider outsourcing collections.

Now that you’ve seen where your revenue gets stuck and what’s slowing down collections, what are you going to do about it?

More importantly—are you willing to continue operating at a loss, or is it time to take control?

For any revenue cycle or A/R management challenges, if you think HealthReimburse can help, shoot us an email at contact@greensensebilling.com or call us at 888-483-1438. We’d be happy to assist you!

1. Inadequate Patient Consent Forms

One of the most common legal pitfalls for small practices is inadequate patient consent forms. This mistake can lead to serious legal repercussions, including lawsuits for malpractice or violation of patient rights.

Why Consent Forms Matter?

Consent forms are not just paperwork. They are a crucial part of patient care.  They ensure that patients are fully informed about the procedures, treatments, and potential risks involved.  Without proper consent, patients might claim they were not informed, leading to legal battles.

How to Avoid This Mistake?

• Ensure your consent forms are comprehensive and easy to understand. They should cover all potential risks and outcomes. 
• Regularly review and update these forms to comply with current laws and medical standards.
• Consider consulting with a healthcare attorney to ensure your forms are legally sound.

2. Improper Handling of Patient Records

In the digital age, managing patient records can be tricky.  Improper handling of these records can lead to violations of privacy laws such as HIPAA (Health Insurance Portability and Accountability Act), resulting in hefty fines and loss of trust.

The Importance of Patient Confidentiality

Patients trust you with their sensitive information. Mishandling this data can not only harm your reputation but also bring severe legal consequences.  Ensuring confidentiality isn’t just about avoiding fines; it’s about maintaining trust and integrity in your practice.

How to Avoid This Mistake?

• Implement strict data protection protocols. 
• Ensure that all patient records are securely stored, whether digitally or physically. 
• Train your staff regularly on data privacy laws and the importance of patient confidentiality. 
• Use encrypted systems for digital records and secure filing systems for physical documents.
• Consider using Electronic Health Records (EHRs):
  • They can streamline the management of patient information, making it more accessible and organized for everyone involved. 
  • Providers can quickly access patient histories, patients can easily track their medical records, and the billing team can ensure accurate and efficient processing. 
  • This improves overall efficiency and accuracy while enhancing patient care and satisfaction.

To understand the gravity of this issue, take a look at the following: HIPAA Violation Leads to $4.3 Million Fine for MD Anderson Cancer Center In 2018, MD Anderson Cancer Center in Texas faced a significant penalty for violating HIPAA. The institution failed to encrypt portable devices, leading to the loss of patient information.  This breach exposed the personal health information of over 33,000 patients. MD Anderson was fined $4.3 million for not implementing proper encryption measures despite being aware of the risks.  This case underscores the importance of adhering to data protection protocols and ensuring all patient information is securely encrypted.

3. Neglecting Employment Laws

Your staff is the backbone of your practice.  However, small practices often make mistakes regarding employment laws, leading to disputes and potential lawsuits. 

Why Employment Laws Are Crucial?

Employment laws cover a range of issues, from hiring practices to workers’ comp benefits, working conditions, and termination procedures.  Failing to comply with these laws can result in legal actions from current or former employees.

How to Avoid This Mistake?

• Stay informed about local employment, state, and federal laws. 
• Create clear, detailed employment contracts and policies. 
• Regularly update your employee handbook to reflect current laws and best practices. 
• Consider working with an HR consultant or employment lawyer to ensure compliance.

Here’s a real-world example that highlights the consequences of neglecting employment laws: Employment Law Violations Result in Lawsuit and Settlement In 2019, a small clinic in California faced a lawsuit from former employees who alleged violations of state employment laws.  The employees claimed the clinic failed to provide mandated meal and rest breaks, did not pay overtime wages, and did not comply with proper termination procedures.  The lawsuit resulted in a settlement of $500,000, including back pay, damages, and legal fees. This case highlights the critical need for small practices to comply with employment laws.  Clear policies, regular training, and proper documentation can prevent such disputes and protect the practice from legal and financial repercussions.

4. Inadequate Insurance Coverage

Having the right insurance is vital for protecting your practice against various risks, including malpractice claims, property damage, and employee-related issues.  However, many small practices are either underinsured or have the wrong type of coverage.

The Role of Insurance in Healthcare

Insurance acts as a safety net. It helps cover legal costs, settlements, and other expenses that arise from unexpected events.  Without adequate coverage, a single incident could financially cripple your practice.

How to Avoid This Mistake?

• Assess your practice’s risks and get appropriate insurance coverage. This includes malpractice insurance, general liability insurance, property insurance, and workers’ compensation. 
• Review your policies regularly and adjust them as your practice grows and evolves. 
• Work with an insurance advisor who understands the healthcare industry to ensure you have the right coverage.

5. Lack of Compliance with Healthcare Regulations

Healthcare is one of the most regulated industries.  Failing to comply with regulations can lead to severe penalties, including fines, license suspension, and even closure of your practice.

Understanding Healthcare Regulations

Regulations cover various aspects of healthcare, from patient care standards to billing practices and facility safety.  Staying compliant ensures you provide high-quality care and avoid legal issues.

• Stay updated on all relevant regulations. This includes federal laws, state laws, and industry standards. 
• Participate in regular training and professional development opportunities. 
• Conduct periodic audits of your practice to identify and rectify compliance issues. 
• Consider hiring a compliance officer or consultant to oversee this aspect of your practice.

Bonus Point: Avoid Upcoding and Downcoding 

Upcoding and downcoding can lead to serious legal and financial consequences.  Upcoding is when you bill for more expensive services than those provided, while downcoding is when you bill for cheaper services to dodge audits.  But here’s the deal: both are totally illegal and could land you with some hefty fines and a major hit to your reputation.  Therefore it is best to stay as far away from them as possible. Keep your billing straight-up honest and accurate to stay on the right side of the law and keep that trust intact.

How Can You Start Implementing These Changes Today?

1. Review and Update Consent Forms: Take time this week to review your current patient consent forms. 

Are they comprehensive?  If not, update them or consult a legal expert to do so.

2. Audit Patient Records: Check how you store and manage patient records. Implement stronger security measures if necessary.
3. Revise Employment Practices: Ensure your employment contracts and policies comply with current laws. Update your employee handbook regularly.
4. Evaluate Insurance Coverage: Review your insurance policies to ensure they cover all potential risks. Consult with an insurance advisor if needed.
5. Stay Informed on Regulations: Make a plan to regularly update yourself and your team on healthcare regulations. Consider setting up a quarterly review or training session.

By taking these steps, you can protect your practice from legal pitfalls and focus on what you do best: providing excellent care to your patients.  Don’t let legal issues be the downfall of your hard work and dedication.  Take action now to secure your practice’s future.

A Final Thought: Your Practice, Your Responsibility

Remember, as a healthcare provider, you have a responsibility to your patients, your staff, and your community.  Protecting your practice legally ensures that you can continue to serve and make a difference. Stay vigilant, stay informed, and don’t hesitate to seek professional advice when needed.  Your practice’s success and longevity depend on it!

7 Patient Care Strategies for Therapists

1. Prioritize Patient-Centered Communication

Communication lies at the heart of effective patient care, and ensuring that patients feel heard, understood, and valued can significantly improve both their experience and treatment outcomes.

• Active Listening: This goes beyond hearing words—it’s about paying attention to a patient’s emotions, body language, and any unspoken concerns they may have. When you actively listen, it helps build trust and allows you to create a more accurate diagnosis and treatment plan.

• Use Plain Language: Avoiding medical jargon ensures your patients are not overwhelmed or confused. Simple, clear language makes it easier for patients to understand their diagnosis, treatment options, and any instructions you provide.

• Encourage Questions: Make it a priority to create an environment where patients feel comfortable asking questions about their care. This openness leads to better-informed patients and reduces the likelihood of misunderstandings that can affect treatment outcomes.

According to a study, even simple eye contact can increase patient satisfaction.

By focusing on clear, empathetic communication, you foster a deeper connection with your patients, leading to better adherence to treatment plans and an overall more positive experience.

2. Optimize Scheduling for Consistency and Efficiency

Scheduling can be one of the most challenging aspects of therapy practices, especially when patients require regular sessions. Efficient scheduling not only ensures consistency but also helps reduce patient no-shows, maintaining a predictable workflow.

• Flexible Scheduling: Offering flexible scheduling options, such as evening or weekend slots, allows you to meet the diverse needs of your patients, particularly those with busy work schedules or family commitments.

• Automated Reminders: Implementing automated reminders via text or email significantly reduces no-show rates, helping patients remember their appointments and reducing the administrative burden on your staff.

• Buffer Times: Scheduling buffer times between sessions not only helps account for any session overruns but also allows you a much-needed breather, ensuring that you can approach each new session with a fresh mindset.

Learn how HealthReimburse’s practice management solutions can streamline your practice’s scheduling, improving appointments tracking and patient adherence.

Efficient scheduling ensures that you, as a therapist, can provide uninterrupted care, while your patients benefit from consistent, reliable sessions.

3. Build a Collaborative Therapeutic Network

Collaboration is key to providing holistic care for your patients. By working with other professionals, you can gain new insights and provide more comprehensive support for your patients, addressing all aspects of their mental and physical well-being.

• Case Consultations: Regularly engaging with other therapists or healthcare providers allows you to gain fresh perspectives on challenging cases. These consultations provide valuable advice, which not only benefits the patient but also fosters professional growth.

• Interdisciplinary Teams: Working closely with psychiatrists, social workers, or other medical professionals ensures that your patients receive care that integrates all aspects of their well-being, offering a more well-rounded approach to treatment.

• Peer Support: Participating in peer support groups offers a space to share experiences, seek advice, and provide emotional support. These groups are invaluable for gaining new knowledge and coping with the emotional demands of your profession.

Collaboration broadens perspectives and ensures patients receive the most well-rounded care possible.

4. Use Data to Measure and Improve Outcomes

While therapy progress is often seen as subjective, integrating data into your practice allows you to make informed decisions, improving the quality of care you provide and the outcomes your patients achieve.

• Track Progress: Utilize tools such as the Beck Depression Inventory or Generalized Anxiety Disorder Scale to track and quantify your patients’ progress over time, helping you adjust treatment plans when necessary.

• Measure Outcomes: Regularly measuring therapy outcomes allows you to evaluate the effectiveness of different interventions and refine your approaches accordingly.

• Collect Patient Feedback: Continuously collecting feedback from patients helps you understand what’s working and what isn’t. This valuable information allows you to make necessary adjustments to improve the therapeutic experience.

Using data-driven approaches can enhance therapy outcomes and improve patient engagement.

5. Leverage Technology for Better Care and Efficiency

The integration of technology in your practice can improve efficiency, increase patient engagement, and streamline administrative tasks, allowing you to focus more on what matters most—your patients.

• Teletherapy Platforms: Offering teletherapy sessions gives patients the flexibility to attend therapy from the comfort of their homes. It’s a convenient option that also ensures you meet patients’ needs while staying HIPAA-compliant.

• EHRs: Electronic Health Records (EHRs) designed specifically for mental health professionals streamline the process of note-taking, scheduling, and billing for therapeutic practices. This technology helps reduce errors, saves time, and gives you more space to focus on patient care.

• Mobile Apps: Recommending mental health and wellness apps such as mood-tracking tools or meditation apps can help patients engage with their care outside of sessions, further supporting their mental health journey.

By embracing the right technologies, you streamline operations, reduce administrative burdens, and create a more efficient, patient-centered practice.

6. Create a Comfortable and Confidential Therapeutic Environment

The physical space where therapy takes place has a significant impact on the therapeutic process. A comfortable and confidential setting allows patients to feel safe, respected, and more willing to engage in their treatment.

• Therapeutic Space: Create an environment that is warm, welcoming, and free from distractions. Comfortable seating, soothing colors, and calming décor can make a big difference in how patients feel during their sessions.

• Privacy and Confidentiality: Ensure that your space is soundproofed, and that clear policies around confidentiality are in place. These measures will help patients feel secure and more open to sharing personal information.

• Resource Availability: Provide patients with resources such as self-help books, pamphlets, or access to online tools to support them outside of sessions. These resources offer additional support and empower patients to take charge of their healing process.

A well-designed therapeutic space can make patients feel safe and valued, enhancing the efficacy of therapy.

7. Focus on Self-Care and Professional Growth

As a therapist, you are your most important tool. Taking care of your own well-being is essential to being able to provide the highest quality care to your patients.

• Regular Supervision: Seek out regular supervision to discuss difficult cases and receive emotional support. Supervision is crucial for maintaining clinical effectiveness and preventing burnout.

• Continuing Education: Attend workshops, conferences, or courses to stay updated with the latest research, techniques, and methodologies in therapy.

• Self-Care Practices: Incorporate self-care into your routine, whether it’s through exercise, mindfulness, or hobbies. Taking care of your mental and physical health is vital to maintaining your own well-being.

• Professional Boundaries: Set clear professional boundaries to protect your time and prevent emotional exhaustion. Learning to say no and delegating tasks when necessary will help maintain a healthy work-life balance.

By prioritizing your own health and development, you ensure that you can continue to provide high-quality, compassionate care to your patients.

Conclusion

Enhancing patient care requires a combination of effective communication, efficient scheduling, collaboration, technology, and self-care. By implementing these best practices, you can create a thriving therapy practice that benefits both you and your patients. Start applying these strategies today, and watch your practice grow, offering healing and support to everyone who walks through your doors.

But First, What is Credentialing?

Before we get into the specifics, let’s clarify what credentialing is.  In simple terms, credentialing is the process of verifying the qualifications of healthcare providers.  This includes checking educational background, training, licensing, and work history. This authentication ensures that providers are qualified to offer the highest standard of care.

Why Credentialing is Important for Your Practice’s Success

Here are nine reasons why credentialing is important for your practice’s success. 

1. Legal Compliance 

First and foremost, credentialing ensures compliance with state and federal regulations. Healthcare is one of the most regulated industries. There are strict rules governing who can provide care and under what conditions.  Failing to comply can result in severe penalties, including hefty fines and, in some cases, even the loss of the ability to practice.  Credentialing is your shield if you want to keep your practice running smoothly without the fear of unexpected legal trouble.  It ensures that all your providers meet the necessary legal requirements, keeping your practice on the right side of the law. 

2. Enhances Patient Trust 

Would you feel comfortable receiving care from a doctor whose credentials are questionable?  Neither would your patients. They expect nothing but the best in terms of medical care. Credentialing helps you deliver on that expectation by ensuring that all healthcare professionals in your practice possess the necessary qualifications, training, and experience to provide top-notch care. When patients see that your practice values professionalism and excellence, they are more likely to choose your services and remain loyal.  Additionally, this trust not only helps to keep existing patients but also draws in new ones through positive word-of-mouth. By verifying credentials such as licenses, certifications, and educational background, you can rest assured that your team is equipped to handle a diverse range of medical needs with confidence and expertise.

3. Streamlines the Hiring Process

Hiring new staff can be a daunting task. Credentialing simplifies this process by providing a clear framework for evaluating potential hires.  Likewise, it is a cornerstone of risk management for your practice. By thoroughly vetting providers through the credentialing process, you mitigate the risk of hiring unqualified or unethical individuals who could jeopardize patient safety or tarnish your practice’s reputation. By verifying qualifications and past performance, you can make informed decisions quickly and confidently. Wouldn’t you prefer to hire a candidate whose qualifications have been thoroughly vetted? Credentialing eliminates guesswork, ensuring you bring only the best and most qualified professionals into your practice.

4. Reduces Risk of Malpractice

One of the biggest fears for any healthcare provider is a malpractice lawsuit. Credentialing helps mitigate this risk by ensuring that all your clinical staff meet rigorous professional standards.  It’s not just about legal compliance; it’s about guaranteeing quality and competence. Think about the potential consequences of a provider making a serious error due to a lack of proper qualifications. Credentialing acts as a safeguard, confirming that your providers have the necessary skills and knowledge to deliver safe, effective care. It includes verifying past performance and ensuring there are no histories of malpractice or disciplinary actions. Imagine the peace of mind that comes with knowing your providers are fully qualified. Credentialing helps protect your practice from legal claims, safeguarding your reputation and financial stability.

5. Boosts Revenue

Want to accept a wide range of insurance plans? Credentialing is a must. Moreover, your health center’s financial success is closely tied to the credentialing process. How? Insurance companies require medical personnel to be credentialed before they reimburse for services.  Without proper credentialing, you won’t get paid! It’s that simple.  In addition, it also allows you to serve a broader patient base. Consider the financial impact: If your medical staff are not credentialed, you could be losing thousands of dollars each month in unpaid claims.  By ensuring all your providers are properly credentialed, you secure your revenue stream, keeping your practice financially healthy.

6. Promotes Professional Development

Credentialing is not a one-time event!  It requires ongoing education and training to maintain certifications and licenses. This continuous process encourages your healthcare practitioners to stay updated with the latest medical advancements and best practices. Furthermore, it gives you an edge over others and allows you to stand out! Isn’t it rewarding to know your team is always at the forefront of medical innovation? Patients benefit from the most up-to-date care.  Credentialing promotes a culture of continuous improvement, ensuring your practice always offers top-notch care.

7. Improves Reputation 

In the competitive healthcare market, reputation is everything.  Credentialing enhances your practice’s reputation, making it easier to attract both patients and top-tier professionals. It shows that you adhere to the highest standards of care and professionalism. Wouldn’t you want your practice to be known as the gold standard in your community? Credentialing sets you apart, boosting your marketability and helping you build a strong, positive brand.

8. Improves Operational Efficiency

Credentialing might seem like a cumbersome process, but in the long run, it improves operational efficiency.  By standardizing qualifications and ensuring all providers meet the same high standards, you streamline many administrative processes. It becomes a smooth, hassle-free operation where every provider meets the required standards without constant oversight.  Credentialing helps you achieve that, allowing you to focus more on patient care and less on administrative headaches.

9. Strengthens Provider Retention

Lastly, credentialing shows you’re serious about helping your team grow in their careers. By backing your team in obtaining and maintaining their credentials, you’re not just ticking boxes. You’re showing them they matter, that their growth matters. It’s about creating an environment where everyone’s expertise is valued and nurtured.  When your staff feels supported in their professional journey, they’re more likely to stick around. Who wouldn’t want to work for a place that invests in their success? And here’s the best part: lower turnover means less time and money spent on hiring and training new faces. It’s a win-win situation. Your team feels valued, your practice stays stable, and as a result, your bottom line benefits as well.

Conclusion: Credentialing is Non-Negotiable

In a nutshell, credentialing is not just a bureaucratic hurdle; it’s a critical component of your medical clinic’s success.  From ensuring compliance and building patient trust to boosting revenue and enhancing your reputation, the benefits are manifold.  Don’t view credentialing as a tedious task—embrace it as an important part of your practice’s growth and stability. Take a moment to assess your current credentialing process.  Are there gaps? Are all your providers fully credentialed?  Investing in robust credentialing procedures today will pay off in spades tomorrow.  Your practice’s success depends on it!

Your healthcare practice is delivering excellent care while also maximizing financial resources to expand services and improve patient outcomes. It might seem ideal, but this scenario is achievable with the transformative potential of 340B Referral Capture—a process that helps practices fully utilize the 340B Drug Pricing Program. This comprehensive guide explains how this process works and why it can be a game-changer for your practice.

What is the 340B Program and Referral Capture?

The 340B Drug Pricing Program allows certain healthcare providers, called “covered entities“, to purchase outpatient prescription drugs at significantly reduced prices. These entities include hospitals, clinics, and other healthcare facilities that predominantly serve low-income or uninsured patients. The program’s goal is to stretch resources, enabling providers to deliver more comprehensive care to those in need.

340B Referral Capture focuses on ensuring that prescriptions written for referred patients also benefit from the program’s discounts. When a patient from a covered entity is referred to another provider—such as a specialist or another clinic—their prescriptions may still qualify for the 340B discount. Referral capture involves:

• Tracking Referrals: Monitoring patients referred to other healthcare providers.

• Eligibility Verification: Ensuring that referred prescriptions meet 340B criteria.

• Coordination: Facilitating communication between the referring provider, referred provider, and pharmacies to share necessary information.

By effectively managing referrals, practices can maximize the financial and operational benefits of the 340B program.

Why Should You Care About 340B Referral Capture?

Financial Benefits

• Maximizing Savings: Healthcare organizations participating in the 340B Program save between 25% and 50% on outpatient drug costs. By implementing a robust referral capture system, you can ensure that every eligible prescription—regardless of whether it is written by a referred provider—benefits from these savings.

• Revenue Growth: Capturing all eligible prescriptions enhances your practice’s financial stability and growth potential by maintaining and potentially increasing savings.

Enhanced Patient Care

• Improving Access: With lower drug costs, patients are more likely to afford and adhere to their prescribed treatments. Studies show that medication adherence significantly improves when out-of-pocket costs are reduced, leading to better health outcomes and fewer hospital readmissions.

• Expanding Services: Financial flexibility gained through 340B savings can fund new services, such as chronic disease management programs, patient education initiatives, or extended clinic hours, enhancing your practice’s value to the community.

Operational Efficiency

• Streamlining Workflows: Managing referrals is often complex and time-consuming. A structured referral capture system simplifies the process, identifying and processing eligible prescriptions efficiently.

• Enhancing Coordination: Improved communication between referring and referred providers ensures better continuity of care for patients, resulting in smoother transitions and comprehensive health management.

Compliance and Audit Preparedness

• Ensuring Compliance: Strict regulatory requirements govern the 340B program. A robust referral capture system helps maintain accurate records, reducing the risk of non-compliance penalties.

• Audit Preparedness: Regular audits are part of 340B participation. Detailed documentation of referrals and prescriptions ensures your practice is audit-ready, minimizing risks while safeguarding program benefits.

Patient Satisfaction and Loyalty

• Improved Experience: Patients benefit directly from lower medication costs and potentially expanded services, fostering higher satisfaction and loyalty.

• Community Focus: Affordable medications and accessible care strengthen your practice’s reputation as a community-focused provider.

How to Optimize for 340B Referral Capture

1. Assess Current Processes: Begin by evaluating your current referral and prescription management workflows. Identify gaps that may lead to missed opportunities for 340B savings.

2. Develop Protocols: Create standardized processes for tracking referrals, verifying 340B eligibility, and coordinating with providers and pharmacies.

3. Training: Educate your staff about the importance of 340B referral capture and how to implement the new protocols effectively.

4. Use Technology: Leverage software solutions to automate and streamline referral capture, ensuring accuracy and reducing administrative burdens.

5. Monitor and Improve: Regularly review your referral capture outcomes. Are all eligible prescriptions being captured? Are there inefficiencies or bottlenecks? Use insights to refine your processes continuously.

Conclusion

340B Referral Capture is more than a process; it’s a strategy for enhancing financial stability, operational efficiency, and patient care quality. By ensuring every eligible prescription is captured and processed, you can unlock the full potential of the 340B Program. Ready to take the next step? Let HealthReimburse guide your practice toward sustainable success.

The ICD-10-CM guidelines serve as their most powerful tool, refined and updated to tackle the latest healthcare challenges.

This year’s changes promise to streamline processes and enhance accuracy. 

Let’s unravel the key updates that every healthcare professional should know.

But First, What is ICD-10-CM?

The full form of ICD-10-CM is ‘International Classification of Diseases, 10th Revision, Clinical Modification’.

Healthcare providers use this system to classify and code all diagnoses, symptoms, and procedures recorded during patient care.

Think of it as a universal language that doctors, hospitals, and insurance companies use to ensure everyone understands the exact condition a patient has and the treatments they receive.

Why Are These Guidelines Important?

The guidelines ensure that healthcare providers and coders use the ICD-10-CM system consistently and accurately.

ICD-10-CM codes are used for:

1. Diagnosing Patients: Each code represents a specific disease, condition, or symptom, ensuring precise communication about a patient’s health.
2. Insurance and Billing: Codes are used to bill insurance companies for patient care, making sure that providers are paid for their services.
3. Research and Statistics: Collecting data on health trends, such as the prevalence of certain diseases, helps improve public health strategies.

New Changes in FY 2025

The ICD-10-CM guidelines undergo updates annually to reflect the latest in medical knowledge and practice. 

For FY 2025, they have introduced several changes aimed at enhancing accuracy, specificity, and ease of use.

The FY 2025 updates highlight changes in bold text and underline items that have been moved.

Key Updates in FY 2025 ICD-10-CM Guidelines

1. New Codes: New codes have been added for emerging conditions and treatments.
2. Revised Codes: Some codes have been revised for clarity and specificity.
3. Moved Items: Certain guidelines have been relocated within the document for better organization.

Here’s a detailed look at some of the most significant updates:

1. Expansion of Codes for Emerging Conditions

With the ongoing evolution of medical science, new diseases and conditions emerge that require precise coding.

• COVID-19 Related Codes: The pandemic has introduced various long-term complications and conditions related to COVID-19. They have added new codes to capture these specific conditions, making tracking and research easier. Such as: 
  • Z86.16 – Personal history of COVID-19: This code is used for patients with a history of COVID-19.
  • M35.81 – Multisystem inflammatory syndrome (MIS): For individuals with MIS related to COVID-19, assign code U07.1 (COVID-19) as the principal diagnosis and M35.81 as an additional diagnosis.
  • U07.1 – COVID-19: The primary code for confirmed cases of COVID-19.
  • J12.82 – Pneumonia due to coronavirus disease 2019 (COVID-19): Used when pneumonia is confirmed to be caused by COVID-19.
  • Z20.822 – Contact with and (suspected) exposure to COVID-19: For individuals with potential exposure to COVID-19 but not confirmed infection.
  • Z11.52 – Encounter for screening for COVID-19: For individuals undergoing screening for COVID-19, including asymptomatic testing.
• Vaping-related Disorders: Due to the rise in vaping and its associated health impacts, new codes now cover a range of vaping-related disorders, from acute conditions to chronic issues.

2. Refinements in Existing Codes

They have revised several codes to provide greater accuracy and correct ambiguities from previous versions.

• Mental Health Disorders: Updates include more detailed codes for mental and behavioral disorders, reflecting the nuanced understanding of these conditions. For instance, new subcategories for anxiety disorders and depressive episodes allow for more precise documentation.
• Neoplastic Diseases: Refinements in codes for cancers, especially those that are rare or have complex presentations, ensure that each type and its specifics are accurately captured.

3. Introduction of New Categories

To better address specific medical scenarios, new categories have been introduced.

• Social Determinants of Health (SDOH): Recognizing the impact of social factors on health, new codes have been introduced for SDOH. These include conditions related to housing instability, food insecurity, and other social challenges.

4. Enhanced Guidelines for Complex Conditions

Some conditions require multi-faceted coding to capture the complete picture.

• Sepsis and Septic Shock: The guidelines now provide more detailed instructions on coding for sepsis, severe sepsis, and septic shock, particularly when these conditions are related to other underlying diseases or complications from medical procedures.
• Chronic Diseases: For chronic conditions like diabetes, hypertension, and COPD, new instructions ensure that all associated complications and comorbidities are accurately documented.

5. Clarifications on Code Usage

To avoid confusion and ensure consistency, several clarifications have been added.

• Use of Placeholder Characters: Clear guidelines on when and how to use the “X” placeholder character have been provided, ensuring no room for errors.
• Laterality Codes: Enhanced instructions on using laterality codes ensure that conditions affecting limbs or paired organs are correctly coded, reducing ambiguity.

Practical Application: A Day in the Life of a Coder

Let’s put ourselves in the shoes of a medical coder. 

Imagine a patient visit with multiple complaints: chronic back pain, a recent bout of pneumonia, and a history of diabetes. The coder’s job is to translate this complex medical story into a series of codes.

1. Back Pain: Look up “pain” in the Alphabetic Index, then verify in the Tabular List. If it’s a chronic condition, use a code that specifies this.
2. Pneumonia: Check if it’s bacterial or viral, then find the precise code.
3. Diabetes: Note any complications or specifics, such as type or use of insulin.

The coder ensures that every aspect of the patient’s visit is accurately captured by following the ICD-10-CM guidelines, allowing for precise billing and comprehensive patient records.

Best Practices for Coders

Staying updated with the latest guidelines is essential for coders. 

Here are some best practices:

1. Regular Training: Attend workshops and training sessions on the latest updates.
2. Stay Organized: Keep your coding manuals and digital tools well-organized for quick reference.
3. Ask Questions: If you’re unsure about a code, don’t hesitate to ask for clarification. Accurate coding is a team effort.

Wrapping Up

The ICD-10-CM guidelines for FY 2025 are more than just a set of rules—they’re a crucial tool for ensuring accurate and consistent medical coding.

By following these guidelines, healthcare providers can improve patient care, ensure accurate billing, and contribute to valuable health research and statistics. As we move forward, these guidelines will continue to evolve, guiding us through the complex landscape of medical coding with precision and clarity.

So, next time you think of medical coding, remember—it’s not just about numbers and letters; it’s about telling the true story of each patient’s health journey.

Managing paperwork, scheduling appointments, handling billing and insurance claims, and maintaining compliance with regulations can be overwhelming.

But, it doesn’t have to stay like this.

Imagine transforming your administrative tasks into smooth, efficient processes that save you time and reduce stress.

Sounds interesting? Let’s explore seven time-saving tips for medical professionals that will streamline your administrative processes and allow you to focus more on what truly matters – patient care.

1. Embrace Electronic Health Records (EHR)

Do you remember the last time you had to sift through a mountain of paper records to find a patient’s history?

Tedious, isn’t it? Embracing Electronic Health Records (EHR) can revolutionize your practice. EHRs centralize patient information, making it accessible with just a few clicks. This saves time and reduces the risk of errors, showing you how to see patients more efficiently.

EHR systems streamline various administrative tasks, such as patient registration, charting, and billing. Moreover, you can quickly retrieve patient histories, track their progress, and share information with other healthcare providers seamlessly.

Investing in a comprehensive and user-friendly EHR system can significantly enhance your practice’s efficiency.

Plus, EHRs often come with features that assist with scheduling, billing, and compliance, further streamlining your administrative processes.

2. Automate Appointment Scheduling

How much time does your staff spend on scheduling appointments each day?

The back-and-forth phone calls, the rescheduling, and the reminders – it all adds up. These methods are prone to errors and inefficiencies.

Automating your appointment scheduling can free up significant time.

Utilize online booking systems that allow patients to schedule their appointments at their convenience. These tools can send automated reminders to patients, reducing last-minute cancellations and no-show rates.

Some advanced systems even offer waitlist features, filling in canceled slots automatically. This not only optimizes your schedule but also ensures that your practice runs smoothly without the constant interruption of phone calls.

3. Leverage Telehealth Services

Telehealth has grown tremendously in popularity, espe

cially following the COVID-19 pandemic. These services enable healthcare providers to conduct virtual consultations, monitor patients remotely, and offer timely medical advice without needing in-person visits.

Integrating telehealth into your practice can streamline administrative tasks by reducing the need for physical paperwork and minimizing patient wait times. It also optimizes healthcare provider schedules, allowing for more flexibility and efficiency.

Enhanced Access to Care

Telehealth also plays a crucial role in enhancing accessibility to care, particularly for patients in rural or underserved areas. By offering virtual consultations, you can reach a broader patient base and provide necessary medical services without the constraints of geographical boundaries.

4. Outsource Non-Core Administrative Tasks

Are you or your staff bogged down with tasks that are not central to patient care? Delegating and outsourcing non-core tasks can be a game-changer. Identify tasks that can be handled by administrative assistants or outsourced to third-party providers.

For example, medical transcription, billing, coding, and even some aspects of patient communication can be outsourced. This allows your in-house staff to focus on more critical tasks and improves overall productivity.

When outsourcing, ensure that you choose reputable providers who comply with healthcare regulations to maintain data security and confidentiality.

5. Implement Efficient Communication Systems

Effective communication within your practice and with your patients is vital.

However, traditional communication methods can be slow and inefficient. Implementing efficient communication systems can drastically reduce time spent on correspondence.

Consider using secure messaging platforms for internal communication. These platforms can facilitate quick discussions, file sharing, and decision-making.

Secure and Efficient

For patient communication, use secure email or patient portals that allow patients to ask questions, request prescription refills, and receive lab results without having to call your office. This not only saves time but also enhances patient satisfaction by providing timely responses.

6. Optimize Revenue Cycle Management (RCM)

Revenue Cycle Management (RCM) is critical for the financial health of any healthcare practice. Streamlining administrative tasks for healthcare practices like insurance verification, claims processing, and payment collections can prevent delays in reimbursement and potential revenue loss.

Implementing automated RCM software can revolutionize how your practice manages its revenue cycles. This software helps identify and correct billing errors, track claim statuses in real time, and automate payment collections. By leveraging these tools, you can reduce manual errors, accelerate the reimbursement process, and improve cash flow.

If this seems like a lot of work for you then consider outsourced RCM services from a top-of-the-line healthcare RCM company. This enhances efficiency and expertise in managing billing processes, ensuring optimal revenue capture while minimizing administrative burdens on your staff.

Financial Stability

Think of RCM optimization as a way to ensure the financial stability of your practice. With efficient RCM practices, you can focus more on delivering high-quality patient care rather than worrying about financial sustainability.

7. Implement Continuous Improvement Strategies

The healthcare industry is always evolving with ongoing advancements. Adopting a mindset of continuous improvement can help your practice stay ahead of the curve.

Regularly evaluate your administrative processes and seek ways to optimize them.

Encourage feedback from your staff and patients to identify areas for improvement. Train and develop your team to keep their skills and knowledge up to date.

By embracing continuous improvement, you can enhance efficiency, reduce costs, and improve patient care delivery.

Conclusion

Streamlining administrative processes in your healthcare practice is not just about saving time; it’s about enhancing the overall efficiency and quality of care you provide.

By embracing EHRs, automating scheduling and billing, delegating non-core tasks, implementing efficient communication systems, and optimizing RCM, you can transform your practice into a well-oiled machine.

Think about it – less time spent on administrative tasks means more time for patient care, less stress for your staff, and a smoother, more efficient practice.

Start implementing these time-saving hacks for doctors today and experience the positive impact on your healthcare practice

Importance of Appointment Scheduling

Appointment scheduling can be affected most from the increase in the number of patients. This task is often taken lightly by administrators but can turn out to be quite challenging and burdensome. As your practice grows, it is important to integrate an appointment scheduling software program, to help manage the increasing number of patient calls seeking appointments. Over time, most medical facilities and hospitals will rely on medical appointment scheduling software. However, in order to be as efficient as possible hospitals, medical facilities and even private practice owners must use the best medical scheduling software for their needs.

Benefits of having an Adequate Physician Scheduling Software

Scheduling appointments over the phone has become quite exhausting and inconvenient for both the patient and the caller. Technological advancement has made doctor appointment scheduling very easy. With online software integration and the use of medical appointment scheduling templates, appointment scheduling has become convenient for doctors and patients. With medical billing software becoming more intuitive, the billing software can allow administrators or front desk workers to conveniently book patient appointments and reservations online through the billing EMR software on a web-connected device. You can also access an online scheduling system from a URL provided to you by your facilities administrator. Once the appointment date and time is confirmed, the medical billing EMR software would automatically confirm the appointment reservation and save and store it in the system without human intervention. In addition to that, medical billing scheduling software can also have other advantages such as sending appointment reminders via emails or SMS messages.  These appointment reminder messages are sent out to the patient on a date, prior to their scheduled appointment. The flexibility and convenience of medical appointment scheduling software can also be used for different purposes related to appointment scheduling such as:

• Planning appointments, treatment plans, and medical services for the patients
• Reserving appropriate vaccinations
• Planning of other medical activities for the administrative staff, front desk workers and patients
• Facilitation and access to medical data including previous lab tests
• Time and monetary savings

24/7 round-the-clock appointment scheduling

Impact of Patient Kiosks Registration on Medical Billing

Although, there still needs to be more patient self-check-in kiosk in healthcare organizations, as these patient sign-in kiosks can be effective for meeting rising patient demands. More hospitals are deploying patient kiosk in emergency and ambulatory departments and outpatient clinics, as they can be efficient for faster patient check-in, registration, finding assistance, checking for appointment schedules, collection of co-payments, checking outstanding balances or filling in basic medical screening questions.  The most essential aspect of these patient kiosks is that they only work as good as their software which is integrated with EHR (electronic health record). Patient check-in kiosk software will not only help to increase patient satisfaction through easier navigation menus but also reduce waiting times and offer greater convenience and privacy as it would be linked and integrated with the EHR software.  Many organizations that offer medical billing along with patient kiosk software, have achieved significant operational benefits with increased patient satisfaction rate, engagement and improved accuracy of patient demographic data records. The success rate of these patient kiosks is high compared with other technologies. They require a small investment that can be deployed selectively with respect to hospital departments or places that require them. However, it is necessary that the patient self-checks in kiosk have the right patient kiosk software with the right functions to allocate scheduling, and other existing related medical billing tasks.

Patient Kiosk Advantages with Medical Billing Services

Patient kiosk registration can streamline all your patient check-in, payments and update your EHR records with just a click of a button. With the right patient kiosk software setup, your patient kiosk can come in handy with real-time updates from your EHR and your practice management system. Patients can just as easily enter their medical data with just a few clicks utilizing their user credentials, password and credit card. Patient Kiosk registration and check-in can always be linked or integrated with practice management workflow including medical billing software, functions, and tasks for the patient. It can also prevent reporting errors by using standard check-in and co-payment processes. With easily configurable workflow reporting and analysis tools, patients can easily enter their information via intuitive menu options. Many patients report that the most difficult part of a hospital or doctor visit is the check-in process as they must wait in long lines or simply going through the difficult process of registration. Patient kiosk simply simplifies and streamlines the process of patient registration by allowing patients to update their personal data, order prescriptions and pay medical bills. It also allows reducing administrative costs and it can be less stressful for the patient to see the doctor. It also removes the redundancy of data entry on paper forms for patient registration and improves upon the visibility of medical account billing and presents the patient billing information through the patient kiosk interface. Patients can see outstanding balances as it allows immediate analysis on their medical record. So, with patient kiosk, it is less frustration for the patients and greater confidence in the accuracy of medical data for the doctors.

Choosing the best quality medical equipment for the disabled patient should be a well informed decision.  DME billing may include wheelchairs, nebulizers, specialized hospital beds, ventilators, colostomy bags, walkers or crutches. 80% of these durable medical equipment expenses are covered up by Medicare alone. The issuance of such medical equipment has to be covered by the patient insurance carrier and is deemed a medical necessity. These type of equipment prescribed to the individual patient depends on the diagnosis given by the medical examiner.

Disposable  medical supplies are another type of medical equipment for daily care. These include blood test strips, disposable gloves, injection needles, and masks, and adherence to HIPAA Compliance is an absolute necessity for the DME facility and medical billing practice.

Things to Consider before Opting for DME Medical Equipment

The Purpose of Medical Necessity:

The medical equipment must be prescribed by a qualified physician. There should be ample proof of the medical condition. One of the primary reasons for patients with chronic illnesses, post surgery or disabilities attaining medical equipment is because they’re bedridden or confined to home.

Usage benefits:

The use of DME aids the healing and management of diseases requiring acute micromanagement. Without the need of frequent or daily hospital visits, allowing the patient the benefits of assisted care without any inconveniences.

Reviews and References:

It is essential to keep a lookout for reviews by the families and caregivers of patients. To help save valuable time and energy while deciding on the right kind of treatment options post-surgery. Or in most scenarios to probe further about the best medical equipment that has been used most frequently. Its best to get a quick reference than to flip through stringent policies or fancy marketing before leaping into an array of information. Credible reviews and testimonies are always thebest way to filter out top of the line technology.

Warranty Period:

The maximum warranty period of DME equipment according to Medicare is at least 3 years. There are specific guidelines in place for the rent and purchase of medical equipment by the United States Health Sector. This is an important factor in mitigating any risks involved in deciding which is the right medical equipment supplier or distributor.

Cost Effectiveness:

With a wide range of diseases rampant all over the world. There is a greater need to calculate the expenses incurred on individualized health care today. With budgetary constraints it is possible to overlook quality standards. Thus choosing the right vendor offering the best value for your money should be a top priority.