All posts by Stephen Brighton

How MHS Can Help Practices Avoid The PQRS Penalties

How MHS Can Help Practices Avoid The PQRS Penalties

The Physician Quality Reporting System (PQRS), is the beginning of CMS’s goal to use pay-for-performance and quality of care instead of paying fee for service.  Submitting the correct PQRS codes can seem overwhelming.  However, if providers do not submit the PQRS codes correctly to Medicare, there will be financial penalties applied to future claims.

The Penalties For Not Participating In The PQRS Initiative

Penalties for Not Participating in or Following the Guidelines of PQRS are the Following:

If you did not participate in or follow the guidelines of PQRS in 2014 there is a 2% penalty on each of your claims for 2016 plus 2% is deducted for sequestration.

If you did not participate in or follow the guidelines of PQRS 2015 there will be a 2% penalty on each of your claims for 2017, plus 2% is deducted for sequestration.

If you do not participate in or follow the guidelines of PQRS in 2016 there will be a 2% penalty on each of your claims for 2018*, plus 2% is deducted for sequestration.

*If you are an individual provider and do not participate in PQRS in 2016, the penalty will be 4% on each claim in 2018  plus the 2% that Medicare already deducts 2% for sequestration.  


Methods of Reporting for Individual Providers and/or Small Practices

Claims reporting                          Registry reporting


MHS is collaborating with Dolby Healthcare Consultants to help practices participate in PQRS in 2016 and choose how to report.  Dolby Healthcare Consultants has a proven track record assisting providers in deciding:


  • How the practice will report the PQRS measures in 2016
  • Which PQRS codes the practice should include when using Claims reporting while keeping in mind:


    • How often the code has to be submitted.
    • The age requirements for the code.
    • The diagnosis associated with each code, if a diagnosis is applicable.


If you are interested in learning more about avoiding these costly PQRS penalties please call Medical Healthcare Solutions at 800-762-9800 X102 for a free consultation.

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Little-Known Advantages to Using a Medical Billing Service

Little-Known Advantages to Using a Medical Billing Service

From time savings to money savings, outsourcing your medical billing to a professional who specializes in this industry can be very beneficial to your company. Particularly if you are a small medical practice, billing can be a demanding and challenging job that takes up a lot of your time and productivity. Using an outside medical billing service to handle these tasks for you is the solution. You may already know that a medical biller can be convenient, saving you from those mundane tasks; however, there are many lesser known benefits to using this type of service.

Reduce Billing Errors

When you entrust your medical billing tasks to an experienced, professional team with training in this area, you get peace of mind knowing your claims are being processed accurately, efficiently, and timely. Handling this on your own or farming this task out to someone within your company who is already taxed with their own duties can lead to mistakes, and those mistakes can be costly. When you choose an independent medical billing service, those professionals focus solely on this service, day in and day out. They have the software, resources, time and extensive training to submit medical claims so that the number of denied claims due to billing errors is reduced.

Save $$$

Outsourcing your medical billing can put more money in your pocket annually, as you could realistically be saving thousands of dollars when it comes to yearly salaries and benefits for an in-house employee. You also save on:

  • Office supplies and furniture
  • Upgrades
  • Billing software
  • Computer equipment

Most medical billing services charge a flat rate or percentage of each claim they handle, but those fees are significantly less than what you would shell out on a full-time employee with insurance and benefits.

Focus on Customer Care

When you don’t have to worry about the stress of technical tasks like medical billing, you can spend more energy and time focusing on what matters most: ensuring your patients get the attention they deserve. It simply isn’t possible for physicians, especially in small practices, to provide superior patient care if they’re pulled in other directions when it comes to the office finances. On the other side of the coin, patient satisfaction in response to that extra attention is increased. Your satisfaction rates will increase, referrals will ideally increase and you can add to your practice one patient at a time.

Boost in Cash Flow

No office is immune to the effects when an employee calls in sick or leaves on vacation. You have to scramble to find coverage for the day or week, while piggybacking those tasks onto someone else’s shoulders within your office that may not have the experience to deal with it. This inconvenience is compounded when your in-house medical biller can’t come in to work and you’re left with a pile of unpaid and unprocessed claims. You may be able to manage for a day, but what if this goes on for days or weeks? As you well know, interruptions in billing processes will delay payments and ultimately hit your bottom line in the form of less cash flow. To keep this cash flow steady, invest in an outsourced medical billing service for seamless operation.

For More Information

Would you like to know more about how outsourcing your medical billing can benefit your company? We would be happy to help. Contact Medical Healthcare Solutions, Inc. (MHS) in Andover today at 800-762-9800 or fill out our convenient online form. Bringing decades of medical billing experience and service to the healthcare community, we are your trusted full-practice Revenue Cycle Management company with customized, confidential solutions.


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How Telemedicine Increases Practice Revenue

How Telemedicine Increases Practice Revenue

As a business in the medical field, you have likely heard about telemedicine and may even implement some aspects of it into your practice. But what is telemedicine? According to the American Telemedicine Association, telemedicine, in a nutshell, is the use of medical information that is exchanged from one site to another through electronic communications in an effort to improve a patient’s clinical health status. It can be accomplished through any number of ways, from two-way video and email to smart phones and wireless tools.

Providers and healthcare systems are readily embracing telemedicine as an additional way to more quickly treat patients and efficiently receive reimbursement for those services. Perhaps you already know how this approach can engage patients and give them access to more and better care. But do you know how it can boost the bottom line for your practice? Luckily, there are many ways.

Reduce Late Cancellations
No-shows are likely the bane of your existence. People who don’t show up for appointments not only throw the whole day’s schedule off, they also take the place of another paying customer. The American Academy of Family Physicians says the average no-show rate is about 5.5 percent. While 65 percent of all practices  track those missed appointments and cancellations, only 46 have policies in place to address the issue. Look, we know there’s no way to predict or control who will show up and who won’t. That’s a given. There are parenting demands, traffic, late work nights, you name it. However, when you provide your patients with a more convenient method of receiving the care they need from home via telemedicine, your patients will be happier and you’ll likely see a reduction in your cancellation and no-show rates.

Boost Patient Flow

Telemedicine can keep the flow of your practice going, getting patients seen, evaluated and on their way without harming their satisfaction rates with you. Virtual check-ins and optimized appointment schedules can help you to achieve all this because patients are more at ease knowing they can ask quick questions without the hassle of coming into the office every time. Happy patients are more likely to book another appointment with you.

Increase Off-Hour and Same-Day Appointments
As a health care provider, you’re already spending many hours handling questions over the phone and returning patient calls without getting paid. Through Telemedicine you now have the option of transitioning those calls to billable units as after-hours telemedicine appointments by converting those patient requests into additional sources of revenue. Designating a separate time for telemedicine for example can increase flexibility during your regular workday to fit in those last-minute same-day appointments. And, by implementing an on-demand list to “see” patients or give them quick answers to questions, patients avoid the hassle of having to hang around your office all day just to get an answer.

Bring in New Patients
When word gets out that you’re offering telemedicine services, new patients will be attracted to your practice because patients want more options for convenient yet accessible healthcare. Just like you, your patients are trying to accomplish more with seemingly less time to do it in. Telemedicine is just the answer to that need.  Get in touch with Medical Healthcare Solutions today to learn more ways in which telemedicine can increase your practice revenue.

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The Importance of Revalidation & Credentialing for Groups & Providers

Medical providers must undergo revalidation and credentialing updates on a regular basis with their insurance carriers to stay current with the latest requirements regarding state and federal guidelines. This process also provides the insurance carriers with the latest information pertaining to their organization so that an active and accurate database of information can be kept on file. The insurance carriers require that all Medical groups and providers go through this process every few years in order to ensure that the correct information on file is maintained.

It is imperative that you do not ignore these requests because a lack of compliance will result in the deactivation of your billing numbers; and, without active provider numbers, a practice will not receive payment. Please note too, that if your number becomes deactivated it may take up to 90 days for reinstatement, impacting your bottom line even further.

Medical Healthcare Solutions, Inc. (MHS) offers complete provider insurance revalidation services as well as comprehensive provider enrollment and credentialing services for initial enrollment. It is crucial to work with a team backed by many years of experience in working with the major commercial carriers such as multi-state Medicare, Medicaid, and Blue Shield, among others. For instance, per, Medicare requires that all providers must revalidate every five years;  and submission of that application must occur within 45 days from the date on the revalidation notice.

Consistent Database

The main advantage of revalidation is to maintain an accurate and timely record of all provider and group information to speed up the process of claims and other medical billing tasks. Credentialing involves the review and validation of the professional qualifications of physicians who apply for participation in select insurance networks. This process is designed to ensure all participating providers meet their strict professional standards, thereby ensuring patients get the highest quality medical attention possible by qualified doctors and other providers.

Many medical billing companies provide complete credentialing services, which include assessment of the requirements by carrier, completion of the application(s), submittal to the carrier(s), and follow-up for processing by carrier(s). A database is then maintained by the billing company to keep track of those records across the board.

Switching hospitals or affiliations? Simply contact your medical billing company to prepare the right letters and forms for you to fill out. In addition, providers must submit credentialing change forms if there are any other changes to their enrollment information such as:

  • Legal business name
  • Practice location (change or addition)
  • Ownership
  • Authorized or delegated official
  • Changes in payment information
  • Legal actions

This is a crucial step in maintaining an accurate profile with your insurance carriers.

Insurance revalidation services work in much the same way. Your medical billing company will help you fill out the paperwork, submit the application and provide all necessary forms. MHS, your trusted provider of cooperative billing, has extensive experience working with a variety of software platforms with the ability to interface with all electronic medical records.

Contact Us

If you are sent a revalidation letter or credentialing request, contact Medical Healthcare Solutions, Inc. (MHS) right away to get going on your application. It’s important to get this information submitted as soon as possible to avoid payment interruptions.

Please contact us today to learn more information on how we can help with your revalidation and credentialing needs. We are proud to have decades of medical billing experience and service to the healthcare community under our belts and look forward to assisting you today!

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5 reasons to start using a medical billing company today

5 Reasons to Start Using A Medical Billing Company Today

One of the most important decisions you will have when opening a medical practice is whether to handle your medical billing in-house or outsourcing it to a good medical billing company. While some medical professionals might prefer a more hands-on approach that comes with in-house billing, there are just too many good reasons to use a medical billing company. Here are just five reasons to consider.

1. It Saves You Time and Money

Since you’ll be outsourcing your billing to a medical billing company, you will have more time to focus on treating patients and performing other tasks associated with a medical practice. Accurate medical billing and coding can take a lot of time and effort, so the seemingly simple task of hiring a company to take care of it for you will make operating your medical practice that much easier. A medical practice that uses a medical billing company can also forego hiring and training staff members for in-house billing. This saves money that can be spent elsewhere to run a more efficient clinic.

2. You Get Your Money Faster

All businesses require a steady cash flow in order to be successful, and private medical practices are no different. While you will still receive payments if you decide to go with an in-house medical billing solution, you will receive payments much faster if you outsource your billing to a company that specializes in it. This is very important for a new practice that has yet to be established and is still working on building a cash flow.

3. It Reduces Rejected Claims

Medical billing is changing constantly, and it’s hard to stay on top of all of those changes. One error can mean a rejected claim, which can be a major headache for any practice. Since medical billing companies specialize in billing compliance, they will be less likely to make mistakes than an in-house billing department, which will lead to fewer rejected insurance claims.

4. You Can Learn How to Make More Money

Medical practices do need to make money to stay afloat, but doctors and nurses need to focus on treating their patients instead of increasing a clinic’s revenue. On the other hand, a medical billing company focuses entirely on improving the finances of its clients. A good medical billing company will keep you informed of changes in health insurance and medical coding, and they will be able to teach you about the changes you can make to your own practice to reduce overhead costs and other expenses that could hurt you in the long run.

5. It Provides Added Security

Finally, medical billing services provide much-needed security to private practices. Any information that is given to a medical billing company is perfectly secure, yet the services offered by such companies are transparent enough that you can access any billing information you may need.

These are just some of the reasons a medical practice should consider using a medical billing service as opposed to an in-house billing department. Most of them come down to outsourcing the work to a company that specializes in billing, coding and finances while your staff can focus on treating patients, and that makes a big difference for any medical practice. Whether your practice has been around for years or it is just starting out, you can definitely benefit from a great medical billing company.


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