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Physician Practices Pressured to Review Revenue Cycle Management

Greg Freeman, June 7, 2013

"Especially the commercial plans, they are going back further and more extensively to review claims," he says. "If you refuse, they are offsetting it against future claims to the provider. That's led to a lot of complaints from doctors lately, even though Medicare and Medicaid audits are nothing new.

Those claims audits are looking for fraud, but with these commercial payers they are just looking back and saying, 'We think we overpaid you, so give us back a couple hundred grand or a couple million dollars.' "

Schwartz notes that the some practices are revising their denial management processes to take advantage of new regulations that provide more ability to stop such audits and ongoing denials.

He cautions that much of the impact of the PPACA is still to come, while the meaningful use requirements are in effect now. The strict nature of those requirements often are underestimated, he says.

"A lot of people don't understand that just buying software doesn't cover you," he says. "The detail required in the security risk analysis is going to start affecting reimbursement going forward, so that's something where you need to get your house in order."

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