Medical Practice Operations - Business Fundamentals 101 - 8 Module Webinar Series with Book-255193

255193 - Article 9

Pdf Summary

The presentation module titled "Business Fundamentals 101: Medical Practice Operations" from Wipfli LLP focuses on coding within medical practice operations. Led by Jeffrey T. Gorke, an experienced healthcare consultant, the session aims to provide a simplified understanding of coding and billing, with touches on revenue generation processes. It emphasizes that the information is educational, advising participants to consult legal counsel for legal matters related to healthcare.<br /><br />The presentation highlights coding basics within the healthcare industry, explaining the role of Current Procedural Terminology (CPT) codes in billing insurance payors for services performed by clinicians. These codes, developed by the American Medical Association, determine reimbursement rates, augmented by Diagnosis Codes (DX) from the International Classification of Diseases (ICD-10) to support the billing level. Challenges often arise in contracting and fee schedules between healthcare clinics and insurers.<br /><br />Key steps in medical billing include coding, documentation, claim submission, and handling payments and denials. Payors contract with clinicians to stipulate service reimbursement based on CPT codes, and clinics often struggle with adjusting contracts and fee schedules.<br /><br />Revenue Cycle Management (RC) is addressed, stressing that it encompasses more than billing and collection, focusing on overcoming revenue challenges such as uncollected receivables. The presentation includes discussions on factors affecting revenue, like clinic size, competition, and negotiation power with insurers.<br /><br />The module also discusses critical performance indicators (KPIs) for monitoring medical practices, including charge analysis and adjustment procedures. Benchmarking these KPIs aids in managing costs, understanding revenue flows, and pinpointing operational inefficiencies. Challenges often noted in reports include delays in chart sign-off, issues with coding accuracy, and problems with receivable collections.<br /><br />In summary, medical practice operations are complex due to coding intricacies and insurer negotiations, emphasizing the importance of understanding coding, billing, and revenue cycles to maintain financial health.

Keywords

medical practice operations

coding

billing

Current Procedural Terminology

revenue cycle management

performance indicators

healthcare consultant

insurance reimbursement

fee schedules

revenue generation