Staffingly Revenue Cycle Managment Outsourcing (RCM)’s Post

The most important factor that makes physicians money is often the combination of their specialization, patient volume, and the reimbursement rates from insurance companies (we can help with both the insurance companies with our medical billing services and patient volume using our well-care services!). Here’s a breakdown: Specialization: Certain specialties, like orthopedic surgery, cardiology, and dermatology, typically have higher reimbursement rates compared to primary care fields. Patient Volume: The ability to see a high number of patients can significantly impact income. This is often facilitated by efficient practice management and effective scheduling. Insurance Contracts: The types of insurance accepted and the rates negotiated with those insurers play a crucial role in determining revenue. Procedures vs. Consultations: Physicians who perform a lot of procedures or surgeries often earn more than those who primarily provide consultations. Geographic Location: Income can vary significantly based on the region, as some areas have higher demand for certain specialties. Practice Ownership: Physicians who own their practices may have higher earning potential due to profit-sharing, but they also bear the costs and risks of running a business. Reputation and Referrals: A strong reputation can lead to more referrals, increasing patient volume and income. These factors together shape a physician's overall earnings potential.

The most important factor that makes physicians money is often the combination of their specialization, patient volume, and the reimbursement rates from insurance companies (we can help with both the insurance companies with our medical billing services and patient volume using our well-care services!). Here’s a breakdown: Specialization: Certain specialties, like orthopedic surgery, cardiology, and dermatology, typically have higher reimbursement rates compared to primary care fields. Patient Volume: The ability to see a high number of patients can significantly impact income. This is often facilitated by efficient practice management and effective scheduling. Insurance Contracts: The types of insurance accepted and the rates negotiated with those insurers play a crucial role in determining revenue. Procedures vs. Consultations: Physicians who perform a lot of procedures or surgeries often earn more than those who primarily provide consultations. Geographic Location: Income can vary significantly based on the region, as some areas have higher demand for certain specialties. Practice Ownership: Physicians who own their practices may have higher earning potential due to profit-sharing, but they also bear the costs and risks of running a business. Reputation and Referrals: A strong reputation can lead to more referrals, increasing patient volume and income. These factors together shape a physician's overall earnings potential.

Every one should fallow this chart

ASC Data has released it's latest ASC Industry Overview. Here's the summary. The Ambulatory Surgery Center (ASC) market is a rapidly growing segment of the healthcare industry, currently valued at $45.6 billion with over 11,700 centers nationwide. ASCs offer patients a cost-effective and efficient alternative to hospital-based outpatient surgery, specializing in a narrower range of procedures with a focus on quality and patient satisfaction. Key Market Trends: + Growth and Innovation: Technological advancements and favorable regulations have fueled market growth, with a projected value of $55.3 billion by 2029. + Shifting Landscape: More facilities are becoming Medicare-certified, and private insurance is increasingly covering outpatient procedures. + Cost Efficiency: ASCs offer significant cost savings for patients, insurers and Medicare compared to hospital outpatient departments. + Evolving Specialties: While specialties like endoscopy and ophthalmology dominate the ASC space, cardiology, musculoskeletal, and orthopedics are experiencing rapid growth. + Challenges: ASCs face challenges such as anesthesia costs, nurse shortages, and pressure on profitability due to increasing partnerships with private equity and management companies. Ownership and Structure: + Physician ownership remains dominant, although hospital and corporate partnerships are increasing. + ASCs vary in size, with most having 1-4 operating rooms. + The majority of ASCs specialize in one or two specialties, contributing to their efficiency and expertise. The ASC market is poised for continued growth, driven by an aging population, technological advancements, and increasing demand for outpatient services. However, navigating challenges like workforce shortages and evolving reimbursement models will be crucial for sustained success. Stakeholders can support the ASC industry by: +Using and sharing accurate market data from reputable sources. +Contributing to ASC advocacy efforts. +Supporting organizations like the Ambulatory Surgery Center Association (ASCA) and the ASC QUALITY COLLABORATION INC (ASCQC). View the full #ASCDATA report below or by visiting https://lnkd.in/gdMnMy5W #surgerycenters #ambulatorysurgery #healthcare

Hi Everyone, CPT Modifier 58, 59, 78, 79, 24 Modifiers 58, 78, 59, 79, and 24 are CPT modifiers applied to surgery claims. They each have very specific, though related definitions. They often cause confusion, especially between modifiers 58 and 78, but also among 59, 79, and even 24. Here are the definitions, according to Current Procedural Terminology (CPT): ✓ Modifier 58 Definition: “Staged or related procedure or service by the same physician during the post-operative period.” ✓ Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.” ✓ Modifier 79 Definition: “Unrelated procedure or service by the same physician during a post-operative period.” ✓ Modifier 59 Definition: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day…” ✓ Modifier 24 Definition: “Unrelated E/M service by the same physician during a post-operative period” Knowing when to choose modifier 58 over 78 or 79 over 78 is vital. Why? Using the wrong modifier can mean denied claims. The different modifiers also carry varying reimbursement schemes. For instance, Modifiers 59 and 78 can reduce Medicare reimbursement below 100%. • Modifier 58 and modifier 78 are often mixed up, because both refer to related procedures by the same physician in the post-operative period. However, modifier 58 generally describes staged/planned procedures, while modifier 78 is used for unexpected procedures. • Modifiers 59 and 79 can be confused as well. Both can refer to unrelated procedures by the same physician. However, 79 focuses on the post-operative period, while 59 centers more specifically around same-day or same-session procedures. • Finally, modifier 24 covers only E/M services by the same physician during the post-op period. • Billing with the right modifiers means less denied claims and higher reimbursement. That means health care workers can ultimately save money for employers. The decision tree below aims to simplify the choice between modifiers 58, 78, 79, and 59. 👉 Follow me for more updates: Shorya Rastogi 👍 Like ✍ Comment 🤝 Share #winwithbestwishes #CPTModifiers #SurgeryClaims #SurgeryCoding #ModifierUsage #CleanClaims #AvoidDenials #Reimbursement

Managed care contracting can have a positive financial impact for both orthopedic practices and ambulatory surgery centers (ASCs) in several ways: **Increased Patient Volume:** Managed care contracts can provide access to a larger pool of insured patients, leading to potentially higher patient volume for orthopedic practices and ASCs. This can improve revenue and spread operational costs over a larger number of procedures. **Predictable Revenue Streams:** Managed care contracts often come with pre-determined rates for specific procedures. This predictability allows for better financial planning and budgeting for both practices and ASCs. **Reduced Administrative Burden:** Managed care contracts can streamline the administrative process by reducing the need for multiple billing and collections efforts for different insurance companies. **Improved Efficiency:** Managed care contracts may incentivize practices and ASCs to become more efficient in their operations to meet pre-determined quality and cost targets. This can lead to cost savings in areas like surgical supplies and staffing. **Focus on Quality Care:** Managed care contracts often come with quality metrics that need to be met. This can encourage practices and ASCs to focus on delivering high-quality care, which can lead to better patient outcomes and potentially higher patient satisfaction, attracting more referrals. Here are some additional points to consider: * Managed care contracts can vary significantly in their terms and conditions. It's important for orthopedic practices and ASCs to carefully evaluate each contract before signing to ensure it aligns with their financial goals and patient care philosophy. * Negotiating favorable contract terms is crucial to maximizing the financial benefits of managed care contracting. * Success with managed care contracting often requires investments in technology and data analysis to track performance metrics and ensure compliance with contract terms. Overall, managed care contracting can be a valuable strategy for orthopedic practices and ASCs to achieve financial stability and growth, but careful consideration and strategic planning are necessary to ensure its success. Credits to #nimble

🧐 What do robot-assisted surgery, breast reconstruction meshes and next-generation sequencing have in common? 👀 They are highly innovative, they have great potential for improving patient health, and main point: their cost is often not fully reimbursed by many European healthcare systems. There are 3 reasons to explain the latter: 1.          Providing scientific proof of the benefits of innovative medical devices ✍️ This is an essential step, but also a real challenge. To meet this challenge, alternative or complementary evaluation models are being developed. Real-life studies are also relevant for measuring the results and risks of innovations. 2.          Demonstrating the cost-effectiveness of innovative medical devices 💰 Medico-economic studies are particularly important for determining the impact of a device on health insurance expenditure. It is therefore necessary to provide a study file that includes all aspects of the intervention (devices, hospital environment, staff training, disposable products, etc.). 3.          Provide consistent training and guidelines for medical devices 🎓 The introduction of new technologies can disrupt the learning curves of medical staff. Without adequate training and clear guidelines, regulators will not be inclined to integrate and reimburse them. 👉 Exciting questions not to be missed in our article of the day written by Charlotte Fosse : https://lnkd.in/dusxBk-t hashtag #innovation hashtag #reimbursement hashtag #medicaldevice hashtag #health

So proud of the work we are doing at OMS360 and how we are doing it. Focusing on the patient journey and continuously adding value has been rewarded with organic growth. If you build it, they will come. Credit to Trevor Maurer for articulating our vision for our practices. —————— Streamline operations OMS360, a support group for oral surgery practices, drove 40% organic growth in the first half of 2024 after implementing a new patient workflow. "We literally did a time study of our patient journey, the staff, and even the surgeons. From this, we identified six phases of the patient journey and detailed how long each one took for our highest-performing practices," Trevor Maurer, the CEO of OMS360 said. Since then, it rolled out best practices to help all of its offices achieve success in the six areas: patient access, scheduling, insurance verification, treatment planning, treatment, and account reconciliation. —————— #optimization #operations #growth Michael Burcham Anderson Williams Trevor Maurer OMS360 Shore University https://lnkd.in/eK8MEFmn

I’ve been very hesitant to post about this subject for a long time. Mostly because it voices an unpopular opinion about the state of Ophthalmology, going against some of the industry “experts” and what is purported as the new direction of our speciality. That said, I have seen this now abused to an extent I don’t feel comfortable, and I feel it's time that I stop hiding from the fear of criticism.  The innovation and technological advances made in our field have grown exponentially, and have allowed us to perform safe, efficient and efficacious surgery for our patients. In addition, innovations like AI and interoperability will only further augment our ability to care for our patients in the coming years. However, we’ve been largely complacent with the inevitable cuts to Medicare and insurance reimbursement, relying instead on premium cash-based services to bridge the gap in lost revenue and rising overhead. Our societies try to lobby, but our voices are not strong enough to change policy, and we are beginning to let our struggles cascade down to our patients. While there is undoubtedly a place for technology and premium services in advancing healthcare, specifically cataract surgery and vision correction solutions, it's disheartening to see these advancements sometimes being exploited for dishonest gains. Our first priority is doing what’s best for the patient. Unfortunately, I am seeing procedures and services being recommended (...pushed?) that are packaged in a way that makes the endpoint more efficacious for the bottom line instead of what the patient wants or needs. Our ability to cope with our struggles using Intellectualization serves as a potentially harmful vehicle, rationalizing misguided decisions using our knowledge and experience as justification.  We need open and honest discussions about how these services can truly benefit patients without compromising ethical standards or transparency. By confronting these issues head-on, we can ensure that our focus remains on providing the best possible care for our patients, regardless of financial circumstances.  We need to band together to make our voices louder in order to enact meaningful change. I will be posting more about this topic and speaking out about some of the problems we’re facing, while looking for solutions to help ensure we have our patient’s best interests in mind.

United Healthcare extends vertical integration with acquisitions of outpatient surgery centers... astute way to benefit from growth in outpatient procedures, and interesting move to capture an even bigger slice of the healthcare pie https://lnkd.in/dYRYbUyx