NCMGMA News is an official news resource of the North Carolina Medical Group Management Association (NCMGMA).
Articles published in NCMGMA News contains the expressed opinions and experiences of the authors and do not necessarily represent the position of NCMGMA.
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2024 Alliance feature article courtesy of Relatient
With multiple locations in the Raleigh area, Raleigh Orthopaedic was on a mission to provide the highest quality of musculoskeletal care – which included providing faster, more convenient care access to patients. Provider preferences became increasingly difficult to manage, which resulted in unbalanced provider schedules and created longer appointment wait times for patients.
2024 Alliance sponsor feature article courtesy of Nuance Communications, Inc.
As long‑time users of Dragon Medical One, Fisher‑Titus Medical Center was accustomed to using speech recognition technology to ease the burden of clinical documentation. But as they looked to deepen their Nuance footprint with DAX, their administration was unsure how it would fit into their existing workflows. Since deploying Nuance DAX, Fisher‑Titus has reaped the benefits of using the two solutions in tandem to optimize productivity, enhance the patient‑provider experience, improve the quality of documentation, and drive better outcomes.
2024 Alliance sponsor feature article courtesy of Total Medical Compliance(TMC)
In the intricate landscape of healthcare, compliance with regulations isn’t just a choice but a necessity. HIPAA stands as a beacon of privacy and security standards within the industry. Among its many components, one crucial element often overlooked, yet central, is sanction screening.
What is Sanction Screening?
Sanction screening involves the meticulous examination of individuals and entities involved in healthcare to ensure they’re not excluded from federal or state healthcare programs. These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses.
Why is Sanction Screening Vital Under HIPAA?
Regulatory Compliance: HIPAA mandates the protection of patient information and the prevention of fraudulent practices. Sanction screening aligns with these objectives by identifying and excluding individuals or entities involved in malpractices, thus upholding HIPAA compliance.
Patient Safety: Patients deserve care from credible and trustworthy healthcare providers. Sanction screening helps maintain this by preventing unauthorized or shady entities from accessing patient information or delivering healthcare services.
Financial Integrity: Fraudulent practices not only compromise patient well-being but also strain financial resources within the healthcare system. Screening out sanctioned individuals or entities contributes to preserving the financial integrity of healthcare programs.
Reputation Management: Healthcare providers, institutions, and organizations strive to maintain an untainted reputation. Engaging with sanctioned entities could damage this reputation irreparably, leading to loss of trust among patients and partners.
The Process of Sanction Screening
Sanction screening involves regular checks against various databases to ensure that healthcare providers, employees, contractors, and vendors are not on any exclusion lists. Automated tools expedite this process, flagging potential matches for further manual review.
In a realm where patient well-being and data security are paramount, sanction screening emerges as a crucial safeguard. Compliance with HIPAA isn’t just about meeting regulatory requirements; it’s about fostering a culture of trust, integrity, and excellence in healthcare.
As the healthcare landscape evolves, the importance of sanction screening under HIPAA remains steadfast. Its role in preserving patient trust, financial stability, and regulatory adherence cannot be overstated. Embracing this practice isn’t just a choice but an imperative step towards fortifying the very foundation of the healthcare ecosystem.
Ensuring compliance with HIPAA through sanction screening isn’t just a checkbox exercise; it’s a commitment to maintaining the highest standards of patient care, confidentiality, and ethical conduct within the healthcare industry. TMC’s exclusion and sanction screening ensures everyone in your practice is compliant while saving you time.
2023 Alliance sponsor feature article courtesy of Nuance Communications
In America’s rural counties, hospitals and clinics are a “centerpiece of economic viability”.1 But how can we maintain these vital centers of wellbeing for towns and citizens in the face of diminishing budgets, physician shortages, and the strain of COVID-19?
Nuance Communications has published a white paper titled “Rural Healthcare in America,” which explores the rural care crisis and the rise of digital health solutions. The white paper is provided as a seven page PDF. To access the paper, click on the button link below.
About Nuance Communications, Inc. Nuance Communications (Nuance) is a technology pioneer with market leadership in conversational AI and ambient intelligence. A full-service partner trusted by 77 percent of U.S. hospitals
2023 Alliance sponsor feature article courtesy of Coronis Health
Medical billing is a critical component of your facility’s revenue cycle, as it ensures that you are earning the reimbursement from the submitted claims of the services you provide. If you are struggling with your accounts receivable, staffing, and an overall lower collection rate, you may need to consider outsourcing your medical billing. There are five significant signs that indicate a need to make the transition to outsourced medical billing.
1. Long Accounts Receivable
Accounts receivable (A/R) is money owed to your facility from an insurance payer; the key is to keep days in A/R less than 30 (ideally). The longer owed money sits in A/R, the longer your facility goes without receiving reimbursements. If your facility’s A/R is 45 days or more, this should be a reason to analyze the core reasons you are not collecting reimbursements or patient payments in a timely manner.
2. Declining Revenue
Part of your revenue cycle is tied to your collection processes, and without a solid foundation of collecting on outstanding payments from insurance payers and patients, you will see a decline in your facility’s revenue. RCM partners focus on providing streamlined billing services for your facility to ensure that you experience an increase in revenue, rather than a decline in the lifeblood of your facility’s operations.
3. Higher Operational Expenses
In-house medical billing is not just about reimbursement for services rendered – operational expenses are a critical component related to the cost of medical billing, which many facilities do not consider in the bigger picture of operations.
The following factors contribute to a higher operational expense for a facility that uses in-house medical billing:
Finding and hiring highly trained and certified billers and coders
Paying hourly wages, which includes the employer share of taxes and employee benefits
Licensing for software (depending on number of employees, you may be charged per license)
Clearinghouse fees
Statement fees and postage, including the cost of printing
Based on how many medical billers and/or coders you employ, a smaller billing department could be less productive and unable to handle the load of increased rejections and denials
Decrease in collections and cash flow
Increase in patient debt
These factors correlate with your facility’s ability to maintain a reasonable rate of operational expenses. When the costs of the above are factored into the cost savings of outsourcing your medical billing, you will discover that the increase in your net collections (your revenue) will surpass not only your previous operational expenses, but the fee you end up paying for your outsourcing. You end up making more in the long run.
4. Lower Net Collection Rate
The net collection rate is the amount of money your facility collects on claims after excluding the adjustments applied by contractual agreements, however, denied claims factor into your net collection rate. An inexperienced medical biller, or a billing department with insufficient staff may write off denied claims instead of engaging in proper follow-up or resubmission of the claim. The rate at which this happens could decimate your facility’s revenue health.
5. High Staff Turnover
Employee turnover relates to multiple factors, from job satisfaction to pay, but in medical billing, an organization may have a difficult time trying to find and keep certified medical billers and coders. This leaves billing departments short-staffed and pressured to keep up with mounting A/R and denial rates, correcting errors, and resubmitting claims.
The average length of employment for a medical biller is anywhere from 1 to 3 years, which means a higher rate of turnover for an organization. The cost of hiring and training has to be factored into the cost of operations, so a high rate of staff turnover is something to consider when determining if you will outsource your medical billing.
Benefits of Outsourcing
One of the key benefits of outsourcing medical billing for your facility is the centralization and standardization of billing practices. Additionally, you will see a lower cost of operations, a decrease in billing mistakes, improved compliance, and above all else, happy patients.
Lower Costs
Operational costs come with the territory of running a medical facility, but you want to keep them under control to ensure a healthy revenue stream. On average, most healthcare facilities can spend anywhere from 30 to 40 percent of their revenue on medical billing, but outsourcing this process significantly reduces operational costs. The money spent to train, recertify, and keep medical billers up to date on the latest regulations is an additional cost, and is eliminated when the billing process is outsourced.
Fewer Mistakes
Billing errors can create a potentially large hit on your revenue. Errors include inefficient collection policies, incorrect coding, errors with patient registration and insurance verification, and lack of documentation with a claim. One mistake can result in a denied claim or delayed payment, and will ultimately result in continued mistakes with costly results.
Medical billers specialize in many fields, from surgery, primary care, behavioral health facilities, to hospitals, so it’s important to outsource with the right company that understands the intricacies of your facility. This ensures that you see fewer mistakes with billing, which means your net collections increase, your denials decrease, and your operational costs are more than manageable.
Improved Compliance
Healthcare is a dynamic industry – regulations change to accommodate fluctuations with government requirements, insurance payers, and changes with technology and science. The Centers for Medicare and Medicaid (CMS) also implement strict guidelines for billing, so it’s important for a medical biller to be up to speed on changes that can affect the billing process for a facility.
Certified medical billers and coders must learn and understand the regulations that govern how insurance payers reimburse, and how facilities must document to receive reimbursement. They are trained on how to apply coding that correlates correctly with clinical documentation, and are consistently updated on any changes that apply to coding or billing procedures. Outsourcing your medical billing ensures that you are working with a team that focuses 100% of their time on billing. You will see an improvement in compliance with billing regulations as your outsourced billing is following the guidelines set forth by the government and CMS.
Happier Patients
Patient experience is an integral part of success in healthcare, as it signifies the quality, reputation and culture of the organization and its people. When patients are happy, there are multiple facets to that level of happiness, and it includes their perception of the billing process. A facility understands revenue cycle and everything it entails, but patients look at only what they can see – registration, insurance, what they have to pay up front, what they are billed, and their interactions with a billing department. When you keep your billing processes in-house, your support staff, which also includes your billers and coders, have responsibilities that extend to scheduling appointments, managing calls from patients, and other tasks that remove the focus from the purpose of their job – billing and coding.
By outsourcing your facility’s medical billing, you are freeing up your staff to focus on creating the best experience for your patients. One of the most difficult aspects of keeping billing in-house is fielding the many phone calls related to patient bills, which sometimes involves more than just the billing department to resolve. Outsourcing medical billing gives your staff the ability to engage with patients without the stress of having to discuss a bill. With a better patient experience, you will see higher patient retention and satisfaction.
Outsourcing your billing services may seem like an expense your facility can’t afford, but in truth, it may be an investment your facility can’t live without. By outsourcing, you may find your revenue increases, your operations become more efficient, and your patients enjoy a higher level of care.
2023 Alliance sponsor feature article courtesy of Auxo Medical LLC
The Significance of Adequate Maintenance of Healthcare Equipment
Healthcare equipment is a vital component of providing efficient and safe patient care. But these pieces of advanced medical technology must be treated with care to ensure they function correctly and reliably. Proper maintenance of healthcare equipment is critical for maintaining patient safety, prolonging their lifespan, and preserving their optimal performance. Maintaining medical equipment correctly also helps reduce running costs, which can help healthcare facilities be more cost-effective overall. Having to replace medical equipment prematurely could put an unnecessary strain on a medical facility’s budget. Adequate maintenance also keeps the accidents that could potentially be caused by broken equipment at bay by reducing the risk of serious malfunction or failure.
Total Uptime Across All Facilities, 2021
Regular servicing also helps keep a healthcare professional’s skill set in check and develop their technical knowledge for better operation of the equipment. Manufacturing and maintenance teams often provide customized training for specific medical equipment, which could be necessary for certain procedures. Keeping current with the latest developments in medical technology helps healthcare professionals better serve their patients and expand their field of expertise.
Total # Services Call vs. Calls Closed w/in in 24 hrs, 2021
Increase Uptime and Patient Safety with Preventive Maintenance
Preventive maintenance is key to sustaining the proper performance of healthcare equipment. These maintenance checks should be conducted periodically to assess the condition of the equipment, test the accuracy of their operation, and identify any potential issues that need to be addressed. This helps boost the operation rate of medical equipment and minimize the amount of downtime needed for repairs or replacements. It is also worth noting that preventive maintenance typically requires less time and resources for upkeep compared to corrective maintenance. The latter requires labor and parts, which can add up over time, but preventive maintenance allows for consistent performance at a lower cost.
Case Study: The Benefits of Switching from Manufacturer to a Trusted 3rd Party Maintenance and Repair Provider
In 2021, a 13 hospital regional healthcare system switched from the manufacturer to a dedicated 3rd party as their sole provider of SPD preventative maintenance and repair support.
What did they experience?
25-35% savings in contract value and repair labor costs
91% of all service calls in were resolved during the initial inspection.
A decrease in service calls, combined with improvement in resolution time, resulted in an increase in equipment uptime to nearly 100%.
The main takeaways from this case study show a marked increase in uptime with a significant decrease in service calls. This, along with the cost savings, shows the benefits of having a preventive maintenance agreement, and relationship, with a trusted 3rd party maintenance and repair provider.
Improved Patient Safety
The most important outcome resulting from preventive maintenance is improved patient safety. This can be achieved in a variety of ways; from reducing the risk of medical mishaps due to technical failure, to prolonging the lifespan of medical equipment with proper maintenance that safeguards against the potential malfunction of costly equipment.
Like any other machines, healthcare equipment should be regularly monitored and maintained in order to perform optimally, and to prevent it from breaking down and resulting in costly repairs or replacements. Proper maintenance of medical equipment is essential in making sure that healthcare professionals are able to safely and effectively serve their patients in the most efficient way possible. From improved patient safety and greater convenience, to increased savings in both costs and uptime, the importance of adequate maintenance for modern healthcare facilities should not be overlooked.
2023 Alliance sponsor feature article courtesy of First Citizens Bank
The pandemic wasn’t just a public health crisis. It also created a cybersecurity crisis for businesses.
During this time, companies across the landscape experienced a significant uptick in cybersecurity attacks from emboldened hackers. This was largely due to an increase in remote work, gaps in cyber-awareness among employees and companies using third-party cloud solutions with unforeseen security vulnerabilities.
The types of cybersecurity threats businesses must now address aren’t that different from the threats they’ve previously faced. However, hackers are now using more sophisticated means—including artificial intelligence—to automate how they attack devices and systems.
Here’s what you need to know about the top cybersecurity threats and how to protect your business.
Types of cybersecurity threats
The most pressing cybersecurity threats businesses of all sizes face fall into several key categories.
Phishing This type of cyberattack involves malicious links sent by email that appear legitimate. Clicking these links or opening these emails unintentionally can give hackers access to sensitive data, whether it’s personal information or operational and customer data your business collects. Hackers have even gotten more sophisticated with their social engineering schemes and have turned to new methods like smishing to gain unauthorized access to data.
Ransomware Now the leading threat for companies, ransomware attacks involve hackers gaining access to sensitive data, encrypting it and then demanding a ransom to restore access. Ransomware attacks can cause massive disruption, as witnessed in the gas shortages on the East Coast in May 2021 due to a ransomware attack on a major pipeline. In this situation, Colonial Pipeline paid almost $5 million to restore access to its data—a hefty sum that many small businesses can’t afford.
Weak cloud and endpoint security Increased usage of cloud solutions opens businesses to more types of cybersecurity threats, especially if they don’t have strong endpoint security. Cloud solutions store and transmit data on virtual servers, which may give hackers an easier entry point compared to a physical server—especially if the providers don’t practice strong enterprise security. Businesses also increase risk if they don’t update their software with the latest security patches. As more employees work from home and connect their devices to remote networks, your business also may encounter increased security risks.
Educate yourself—and your employees Take steps now to raise your and your employees’ cyber-awareness. If you don’t have the resources to invest in robust cybersecurity training, the National Institute of Standards and Technology maintains a list of free and low-cost cybersecurity training resources, Opens in a new tab. You can reinforce this material in company newsletters, communications and in-person conversations to build employee awareness.
Monitor your cloud applications If you have even a small budget for cybersecurity, it’s worthwhile to invest in cloud-monitoring tools. These solutions can watch out for activity on your network and send alerts when there’s something suspicious. Some types can even isolate these threats from your network so hackers can’t access sensitive information. If you can invest in any technology, security may generate the most value for your company.
Keep your systems and devices updated One of the simplest things you can do is keep your computer systems, software applications and devices up to date. Many technology providers update their software automatically, but they might also send notifications to remind you to do this on your own. However, in some cases your technology may be so outdated that it’s better to replace it with modern security capabilities that reduce your risk.
Create a cybersecurity policy Although you may think a cybersecurity policy is only for large enterprises, small businesses also can benefit from establishing one. Your policy doesn’t have to be complex or long, and you can use online templates as a model. Taking the time to map out your policy is important because it gives employees something physical they can consult to boost their cybersecurity knowledge.
Getting ahead of threats
As more organizations digitize their operations, cybersecurity threats will continue to increase. Businesses of all sizes must be proactive in this evolving threat landscape, so consider implementing these best practices so you can reduce your risk and protect your business.
Disclosures
This information is provided for educational purposes only and should not be relied on or interpreted as accounting, financial planning, investment, legal or tax advice. First Citizens Bank (or its affiliates) neither endorses nor guarantees this information, and encourages you to consult a professional for advice applicable to your specific situation.
Links to third-party websites may have a privacy policy different from First Citizens Bank and may provide less security than this website. First Citizens Bank and its affiliates are not responsible for the products, services and content on any third-party website.
Video Preview! The AI Advantage: Reshaping Healthcare Practices for a New Era Friday, September 15 | 9:30 AM – 10:30 AM
Artificial intelligence is rapidly evolving and has the potential to be a leading tool in many industries, especially healthcare. The summer interns at Prosper Beyond will present “The AI Advantage: Reshaping Healthcare Practices for a New Era”. Here’s a sneak preview!
New Friday Panel Discussion Announced! Protecting Your Practice from the Risks of Today and Tomorrow Friday, September 15 | 10:30 AM – 12:00 PM
Medical practice leaders are confronted with a number of business and clinical risks every day – and the areas to monitor seem to be escalating with new regulations, patient expectations, and the evolution of the healthcare industry overall. From financial and operational risk, to clinical and reputational risk, join the Curi Advisory team for this panel discussion to explore opportunities to help prepare, protect, and optimize your practice today and well into the future. See our complete agenda here.
New One-day Registration Option for Thursday! We’ve added a one-day pass option for members-only for Thursday, September 14th. This one-day registration includes all Thursday sessions, access to the exhibit hall, lunch and all refreshment breaks. Please note: Thursday pass does not include breakfast or dinner.
Earn up to 11.5 CEU credits at the Fall Conference.
See our full Fall Conference event information here.
Conference Highlights
Conference Speakers Bestselling author Dr. Gary Chapman, ACMPE Liaison for NC Michelle Wallace, organizational psychologist Joe Quitoni, the interns from Prosper Beyond, panelists from Curi Advisory, revenue cycle expert Elizabeth Woodcock, and more are joining us in September. Learn more about our speakers here.
Hotel Accommodations The Grandover Resort & Spa is centrally located in North Carolina near Greensboro. We are past our room block cutoff. To check availability and make reservations, please contact the hotel directly at 336-294-1800.
Exhibitors From information technology to linen services, our sold out exhibit hall is the go-to resource for all your practice needs. See who’s joining us and start making plans to meet the companies providing healthcare with industry-leading products and services. See our exhibitors here.
Fall Conference Dinner & Social
Register Today!
There’s still time to join us at the Grandover Resort & Spa. See all of our conference pricing here. To register today, please follow the online registration link below.
See our full Fall Conference event information here.
Conference Highlights
Conference Speakers Bestselling author Dr. Gary Chapman, ACMPE Liaison for NC Michelle Wallace, organizational psychologist Joe Quitoni, revenue cycle expert Elizabeth Woodcock, and more are joining us in September. Learn more about our speakers here.
Hotel Accommodations The Grandover Resort & Spa is centrally located in North Carolina near Greensboro. According to The NCMGMA room block rate is $229 per night. Visit this link to make reservations. The room block discounts end August 23rd.
Exhibitors From information technology to linen services, our exhibit hall is the go-to resource for all your practice needs. See who’s joining us and start making plans to meet the companies providing healthcare with industry-leading products and services. See you list of exhibitors here.
Register Today!
Full conference costs start at $425 for members and new this year is a single-day pass starting at $199 for members. See all of our conference pricing here. To register today, please follow the online registration link below. Best value pricing ends August 23rd.
2023 NCMGMA Fall Conference September 13-15 | Grandover Resort | Greensboro, NC
Come to the Grandover Resort & Spa, September 13-15, and experience practice management-specific continuing education, our industry’s best products and services on display in the exhibit hall, and plenty of social and networking opportunities. Can’t get away for the full three days? New this year: we’re offering a one-day registration. Don’t let a busy practice keep you from professional development and connection with fellow managers!
Earn up to 11.5 CEU credits at the Fall Conference. Sign up today and get best-value pricing: costs increase after August 16th.
See our full Fall Conference event information here.
Conference Highlights
Conference Speakers Bestselling author Dr. Gary Chapman, ACMPE Liaison for NC Michelle Wallace, organizational psychologist Joe Quitoni, revenue cycle expert Elizabeth Woodcock, and more are joining us in September. Learn more about our speakers here.
Hotel Accommodations The Grandover Resort & Spa is centrally located in North Carolina near Greensboro. According to TripAdvisor, “This newly renovated, elegant hotel really does things right.” The NCMGMA room block rate is $229 per night. Visit this link to make reservations.
Exhibitors From information technology to linen services, our exhibit hall is the go-to resource for all your practice needs. See who’s joining us and start making plans to meet the companies providing healthcare with industry-leading products and services. See you list of exhibitors here.
Register Today!
Full conference costs start at $425 for members and new this year is a single-day pass starting at $199 for members. See all of our conference pricing here. To register today, please follow the online registration link below. Best value pricing ends August 16th.
North Carolina Medical Group Management Association Blog 