Nancy Clements

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Navigating Carrier Guidelines for Optimal Practice Reimbursement

Posted by Nancy Clements on Jul 6, 2023 4:25:20 PM

When a Medicare patient has multiple sources of insurance coverage, Medicare will only pay for services after the primary payer has processed the claim and made their payment.  Medical office staff must always verify the patient's insurance coverage thoroughly - gathering all necessary information from the primary insurance, such as policy numbers, claim submission instructions, and any preauthorization requirements, etc.

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Topics: Practice cash flow, payer contract, carrier contract, carrier contract guidelines, medicare compliance, patient billing, claims, insurance

Crisis Leadership for Medical Office Managers

Posted by Nancy Clements on Oct 31, 2022 11:34:57 AM

You are thinking about the busy workday ahead as your car inches forward in heavy morning traffic. An incoming call from the medical office building manager changes the trajectory of your day. Downed power lines from a heavy storm have forced the offices to close indefinitely. Water has seeped into the building. Now your thoughts shift to the patient load for the week, in-office procedures scheduled for the day, and communicating with staff heading into the office. How can you address the closure, property damage, system outages, and other unknown perils as quickly as possible?

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Topics: CMOM, medical office manager topics, medical office compliance, workplace violence, leadership, workplace safety, Crisis Leadership

Managing Through a Crisis

Posted by Nancy Clements on Apr 13, 2022 5:01:53 PM

By now, every medical practice leader in the nation has completed the "school of hard knocks" apprenticeship in Crisis Management, compliments of COVID-19. Hopefully, most have made it through unscathed and learned a lot in the process. Now that the pandemic waves appear to be subsiding, some medical office managers may be wondering whether to relax protocols and get back to pre-pandemic normalcy, stay on course, or prepare for new possible threats. The answers will present themselves in due time. 

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Topics: medical office compliance, workplace violence, emergency preparedness, Opioid Addiction, medical office leadership, personnel management, Practice safety

Meet Kathleen Riexinger - PMI's Director of Student Experience

Posted by Nancy Clements on Feb 2, 2022 1:04:21 PM

Whether you are new to Practice Management Institute, a certified professional, enrolled in, or inquired about medical office training, you have probably interacted with Kathleen Riexinger at some point. She has worked with PMI for two decades and recently received a well-deserved promotion to Director of Student Experience. She chose the new title, said PMI President/CEO David T. Womack, and it fits her to a tee.

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Topics: Practice management, medical office manager topics, medical practice issues, medical office staff, administrative burdens, medical office leadership, medicare compliance

Successful Patient Collections: Test Your Knowledge

Posted by Nancy Clements on Jan 28, 2022 8:00:00 AM

Consumer healthcare spending continues to rise, not surprisingly due in part to the COVID-19 pandemic. National health spending projections for 2021-23 will continue to inch upward 5.4 percent per year, according to research compiled by the National Health Expenditures Accounts (NHE). Insurers have tightened the reins shifting more financial burden to their members. And with inflation, furloughs, unpaid family leave, and mounting medical and prescription costs, it's no surprise that family budgets are stretched thin.

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Topics: Practice debt, medical practice issues, medical billing, patient billing, patient collections

Why Quality Documentation Matters

Posted by Nancy Clements on Nov 10, 2021 3:45:00 PM
If you work with provider claims in a medical office, then you have probably heard the phrase, “If it isn’t documented, it wasn’t done.” But a 2020 Center for Medicare and Medicaid Services (CMS) report found that more than 70 percent of claims submitted for payment were paid improperly, meaning something was incomplete or missing from the documentation submitted with a claim.
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Topics: carrier contract guidelines, medical billing, Medicare fraud, medicare compliance, patient billing

Leading Through Change: Virginia Administrator Shares Journey

Posted by Nancy Clements on Sep 17, 2021 10:30:00 AM

Rachel K. Downey, MHA, is an Administrator at Dermatology Associates of Virginia where she has worked for more than six years. Founded in 1969 by Richmond native Charles M. Caravati, Jr., M.D., the practice has grown to 16 Board-certified physicians and four mid-level providers practicing at six central Virginia locations with a goal to excel in quality, patient experience, and cost-effectiveness.

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Topics: medical practice issues, emergency preparedness, financial management, medical office leadership, COVID, change management

Justice Department Announces New COVID-19 Medicare Fraud Enforcements

Posted by Nancy Clements on Jun 9, 2021 9:15:00 AM

The U.S. Department of Justice (DOJ) on May 26 announced law enforcement actions for several COVID-19-related Medicare fraud schemes totaling $143 million. The actions involved the exploitation of Centers for Medicare and Medicaid Services (CMS) policies designed to increase access to care during the COVID-19 pandemic. Fourteen defendants were charged for their actions involving the exploitation of the broadened COVID-19 emergency declaration, telehealth regulations, and rules. 

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Topics: medical office compliance, medical fraud, Medicare fraud, medicare compliance

Telehealth a Lifeline for Medical Practices: Proceed with Caution Say Experts

Posted by Nancy Clements on Apr 14, 2021 11:30:00 AM

Pay careful attention to the latest reimbursement, compliance guidelines, and waivers as you integrate telehealth into patient care, experts warn. As the newness wears off, denials could start rolling in if you aren't watching the updates closely. 

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Topics: Practice management, Practice cash flow, medical office compliance, medical practice issues, medical billing

Practice Managers and Auditors: Learn to Stand Your Ground with Payers

Posted by Nancy Clements on Apr 13, 2021 5:15:06 PM

Changes to healthcare delivery, and billing codes during the pandemic, along with major updates to the E/M documentation guidelines have created a ripe environment for government-contracted auditors. But you have the right to challenge auditors. Take steps now to establish your culture of compliance.

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Topics: Practice cash flow, payer contract, carrier contract guidelines, medical office, medical billing, financial management, auditing

Practice Transformation Coach Debbie Rozanski Shares Tips to Beat Stress & Gain Confidence

Posted by Nancy Clements on Mar 25, 2021 11:01:16 AM

When demands at work leave you overwhelmed or exhausted, knowing where to turn for support is important before stress builds and spreads into other areas of your life. Relief starts with giving up some control, said Practice Transformation Coach Debbie Rozanski.

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Topics: Practice management, medical office certification, Certified Medical Office Manager, medical practice issues, administrative burdens

Perseverance Through Change: Practice Manager Ashton Ardila's Journey

Posted by Nancy Clements on Mar 16, 2021 3:41:30 PM

Your Family Doktors, a 25-year-old family practice in Webster, TX, faced many operational challenges over the past year as the COVID-19 pandemic sent healthcare into a tailspin. Office Manager Ashton Ardila, CMOM, CMIS, shared some of the hurdles and frustrations her team faced, and how the practice has persevered.

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Topics: Practice management, CMOM, medical office certification, Certified Medical Office Manager, medical office manager topics, medical office compliance, medical office staff, administrative burdens

Education and Hard Work Have Helped Elizabeth Daley Set a Strong Foundation for Career Growth

Posted by Nancy Clements on Mar 10, 2021 12:39:18 PM

Elizabeth Daley, MHA, CMIS, CMOM, CMCO, is Director of Client Success at Collect Rx, a 15-year-old company launched by former executives from third-party vendors who pioneered the out-of-network (OON) industry. The company works with 2,100 clients across the country and have built a proprietary database with thousands of claim resolutions at their fingertips to facilitate and expedite the negotiation process.

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Topics: Practice cash flow, value proposition, carrier contract guidelines, medical practice issues, medical billing, financial management

PMI Certification Renewal Questions Answered

Posted by Nancy Clements on Jan 7, 2021 12:45:00 PM

This time of year, we get a lot of questions from certified professionals about keeping their credentials current. The good news is the process is not too complex. And, with a little pre-planning, renewing your certification(s) can be quick and easy.

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Topics: PMI Certification, medical office certification, medical office staff

Relaxing of the PHI Protections Introduced for Public Comment

Posted by Nancy Clements on Jan 5, 2021 9:07:34 PM

The Department of Health and Human Services (HHS) this week submitted a 357-page proposal for publication to the Federal Register detailing proposed changes to the Privacy Rule under the HIPAA & HITECH Act standards.

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Topics: medical office compliance, HIPAA, administrative burdens

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