The health insurance industry is constantly changing. It seems like every time providers get used to something, there’s a modification or new rule or policy that upsets the apple cart and requires them to learn things all over again. Fortunately, the Internet and emerging technology are making it easier for providers to stay up to date with insurance trends and changes, but it still requires a dedicated effort.
There are several things providers and private practice owners can do to ensure that they are always updated on the most current insurance information and industry news, as well as compliance guidelines and other topics. It all starts with taking the time to get informed and to set your practice up for success with the right tools. Insurance and compliance can be a pain, but they are essential to private practice and its successful operation.
Over the past five years, SME says the need for change has been much larger. Insurance companies are getting more stringent on coverage, telehealth is changing the way that people receive care, and major payors are buying out smaller insurance companies, many of which are going bankrupt.
The new rules result in increased audits (and likely the shutdown of many smaller companies who weren’t following best practices as well as they could). Part of the audit focus is on the abuse of services, including telehealth, and making sure providers aren’t billing out for hour-long video consults when they’re only on Zoom for 20 minutes, for example.
Of course, there have also been some positive changes, SME says. In some cases dealing with Medicaid and CMS, some preauthorized services are being done away with. There’s also a collection of extended services for patients, and electronic processing has reduced claims processing times. However, she cautions, the use of digital platforms increases the importance of coding correctly.
Part of every private practitioner’s day should include reading up on industry news and information. Focus specifically on health insurance and private practices so that you’re not bogged down by all the other topics out there. When you keep up daily, you’ll find that changes are less likely to surprise you.
It’s also important to share this news with the relevant people in the practice. This includes other practitioners, nurses, and (perhaps especially) your administrative staff. Whoever is handling your insurance and billing should also take an active interest in industry news and keeping their skills and knowledge current. The biggest issue in this realm is usually information overload—there’s simply too much information out there and it becomes difficult to sort out what is most relevant.
The good news is that there are also ways to combat that. Subscribe to specific newsletters. Get updates from your insurance partners directly. Set up feeds designated for tracking insurance industry news and updates. And most importantly, make sure that you have the systems in place to course-correct when you learn information that impacts your practice.
Changes to policies have been happening slowly over time, according to SME, while Telehealth and the company buyout are both more abrupt changes. For those who read the news, however, it’s likely these topics are already in mind. You really have to stay on top of things, says SME.
Keeping your systems compliant and updated is important, too. Thanks to technology, it’s becoming increasingly easier to maintain compliance and perform routine checks to scan for inconsistencies, errors, or items that are out of compliance and need to be addressed. However, practice owners cannot just assume that the system will do as it should. Regular compliance checks of both the human and computer operations related to insurance in your practice are a must.
This will allow you to check for things like:
When a practice has all the right tools and systems in place, it becomes much easier to keep up with changes in the insurance world, as well as the healthcare industry itself.
Awareness is a huge part of keeping your practice current with the insurance industry. Simply taking the time to learn about upcoming changes to laws or provider requirements can do a lot to keep you prepared. You should make a note of any important changes that you read about, as well as select a date to follow up and make sure that any work related to those changes is taken care of.
Those who are keeping up with industry news will find that it’s easy to catch important dates and changes that may be coming up throughout the year. You can also post them somewhere in the office that’s easy to see, add them to digital calendars, and even input them in your practice management platform so that nothing gets missed.
SME says the biggest impact has been the lack of communication between payors and practices, including the tendency to put new rules in place and not send notification until much later, which results in practices having unpaid claims, which is hurtful to their bottom line as well as the provider/practitioner relationship.
The tools that providers use to manage their practice will play a large role in helping them stay on top of their day-to-day operations. This can (and should) include insurance information, guidelines, requirements, and other details. An agile practice management solution will be capable of adopting new processes to keep up with the ever-changing health insurance industry, too.
More providers are realizing the value of practice management tools for more than just collecting and storing patient information. Revenue cycle management is huge for private practice and without the right tools, insurance dollars are going out the window to the tune of millions in lost revenue. A total practice management solution can monitor and manage:
ClinicMind offers a total solution for practice management because we understand just how complex it can be. Compliance and documentation, as well as keeping up with them, take up time that could be spent with patients. The ClinicMind practice management suite includes EHR and RCM software along with credentialing and billing services to improve your revenue cycle management.
With automated workflows, shareable patient records, simple documentation, and compliance built in, ClinicMind lets you put patients first without compromising whether the practice will get paid. We also stay updated with the latest insurance industry trends and changes and thusly update the software as needed, guaranteeing that you’ll always have a compliant, streamlined practice management solution.
The health insurance industry is complex enough, let alone having to keep up with the changes and trends that come and go over time. Fortunately, with the right strategies and tools in place, every practice can become more proactive by staying up to date with those changes. The last thing that you want is to deal with a lot of denials or insurance issues because of new information or guidelines that you aren’t familiar with.
Patients rely on you for more than just their health. They also rely on you to make sure that their insurance company does its job. Part of that comes in staying on top of industry news and changes. The other part comes in choosing a reliable practice management solution that includes updates and resources for keeping insurance processes streamlined and compliant, such as the EHR/RCM platform from ClinicMind.