Claims Revenue Tips

AMA practice tip: Eliminating unfair discounts

Physicians are regularly solicited to participate in preferred provider networks (PPNs) via participating provider agreements. But how does a physician know if the agreement is beneficial for the practice? In today’s market of rental networks, it is imperative to understand which organizations physicians are contracting with and what the agreements should contain. View the webinar, “Eliminating unfair discounts” to learn how preferred provider networks work, what the difference is between a primary and secondary provider network and what should be contained in an agreement. This webinar also provides an update on the AMA’s related legislative activities.

AMA practice tip: Obtaining, uploading and utilizing your contracted fee schedules

The AMA has created the educational resource “Obtaining, uploading and Utilizing your contracted fee schedule”to help physicians understand the importance of utilizing thier contracted fee schedules. This resource provides step-by-step instructions on how to upload your contracted fee schedule into your practice management system, as well as guidance on reports or spreadsheets that can help you ensure that payments you receive align with what you agreed to in your contract. If you don’t have copies of your contracted fee schedules, AMA members can access a free template letter to send to payers at www.ama-assn.org/go/templateletters, to request a copy of contracted fee schedules.

AMA practice tip: Understand payment rates and policies before signing a managed care contract

The AMA has created three educational resources to help AMA member physicians evaluate managed care contracts. “Protect your payment: Key questions to resolve prior to signing a contract purporting to base payment on the Medicare Resource-Based Relative Value Scale (RBRVS) or the Medicare Physician Fee Schedule (MFS),” explains the various elements of the RBRVS and MFS to help physicians understand which questions they may need to ask managed care organizations about their payment rates and policies before signing or renewing contracts. Because a clear understanding of the physician’s payment under each managed care contract is crucial to the initial decision of whether to contract with a specific managed care organization and the physician practice’s ability to reconcile claims payment moving forward, the AMA has also created a one-page checklist of these questions for physicians to use when evaluating a specific contract. A longer companion piece, “Fee schedules based on Medicare’s Resource-Based Relative Value Scale or the Medicare Physician Fee Schedule,” details the rationale underlying these questions for physicians who are interested in more specifics.

Visit www.ama-assn.org/go/psa to access these and other contracting resources.

AMA practice tip: Webinars about payment bundling, pay-for-performance and more

In two webinars, you can learn more about key concepts from two authors of the AMA’s “Evaluating and negotiating emerging payment options” how-to manual. The authors discuss how this manual helps physicians who are considering transitioning from fee-for-service payment to budget-based reimbursement. Unlike fee-for-service payment which rewards volume, the primary driver of the economic result in budget-based payment systems is the extent to which the actual cost of providing care to a patient population varies from the projected budget for those costs – physicians who come in at or under-budget prosper, while physicians who exceed the budget are penalized.

These webinars are archived online, so you can watch them at your convenience. For an overview of the manual and how it can help you evaluate, negotiate, and manage budget-based payment systems, including payment bundling, pay-for-performance, withholds and risk pools, capitation and shared savings, view this 12-minute introductory webinar. You can also view the in-depth version of this webinar, which goes into more detail on each of the manual's chapters, in addition to providing an overview of the manual and its concepts. 

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the MGMA offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Access key payer information quickly and easily

Navigating the websites of health insurers to find a piece of information can be complex and tiresome. To ease this process, the  AMA has compiled a list of direct links to the most frequently-sought information for many major payers. Visit www.ama-assn.org/go/payerpolicies to access this resource and reduce the time you and your staff spend searching for answers.

AMA practice tip: Establishing a cost-based practice fee schedule

The AMA has developed the educational resource, “Fee schedule analysis: Using your complete practice cost as a guide,” to help physicians and their practice staff recognize the need to establish their practice fee schedule based on what it actually costs to provide a service rather than basing their fee schedule on what a third-party payer or other entity wants to pay. This resource includes a 12-step guide to help physician practices create their own unique physician practice fee schedule with an easy-to-complete spreadsheet that will allow physician practices to include additional markup percentages to account for profit, contributions to reserves and future capital expenditures.

AMA practice tip: Empower your practice with the National Managed Care Contract  

Take advantage of this comprehensive managed care contracting resource, which is based on the most physician-favorable managed care laws and regulations from all 50 states and the District of Columbia. This empowering advocacy resource and its accompanying supplements address many of the issues that arise in the managed care contracting process and in the subsequent business relationship between physicians and managed care organizations.

Developed by the AMA and state medical association attorneys with expertise in managed care contracting issues and regulations, the National Managed Care Contract includes more than 70 pages of model provisions based on state law and is supported by hundreds of legal citations.

The National Managed Care Contract helps physicians and their advocates:

• Support managed care contract negotiations with reality-based alternative language
• Develop managed care legislation and regulation
• Advance legal research and litigation
• Stay abreast of emerging state and federal legislative and regulatory trends
• Ensure managed care contracts and managed care organizations’ conduct comply with applicable state legal requirements

AMA practice tip: Mastering the claims management cycle

The first step in the claims management cycle is to improve physician practice viability through efficient contracting. When entering into negotiations with the health insurer’s representative, physicians need to be well prepared. The more physicians understand about health insurers, the better they will be able to decide whether a health insurer is suitable for their practice. Access the educational resources “A guide to working with health insurer representatives” and “15 questions to ask before signing a managed care contract.” AMA members can download these informative practice management resources free of charge.

AMA practice tip: Medicare Advantage private fee-for-service (PFFS) plans

PFFS plans are perhaps the most confusing and least understood of the various kinds of Medicare Advantage plans that are in operation. They also are the fastest growing type of Medicare Advantage plan. The AMA has created a new one-page flyer “10 things you need to know about Medicare Advantage private fee-for-service plans” as a quick reference to aid physicians and their staff about the basic operation of these plans. AMA members may visit www.ama-assn.org/go/ma to download a copy of this flyer.

AMA practice tip: Protecting your practice from inappropriate discounts

Multiple payers could be taking advantage of your lowest contracted payment rate through the use of a rental network preferred provider organization (PPO). The AMA developed the resource “Read your contracts: Is your practice losing revenue through rental network PPOs?” to educate physicians about how to identify and protect their practices from inappropriate discounts.

AMA practice tip: Making sense of rental network PPOs

Is one of your practice’s payers utilizing a rental network preferred provider organization (PPO)? These arrangements can be complicated and difficult to identify in advance, often depriving a practice of revenue unfairly. The  AMA has created the educational resource “The tangled web: the rental network PPO industry” to help physicians and their practice staff recognize and protect against payer discounting practices tied to the use of a rental PPO. The resource provides background information about this payment structure, as well as tips for ensuring that your practice avoids entering into unfavorable agreements which could cost you revenue.

AMA practice tip: New AMA resources help physicians understand risk assessment and adjustment models

Two new educational resources from the AMA are designed to help physicians understand health insurers’ use of risk assessment and risk adjustment models and how they might affect the physician practice. “An introduction to risk assessment and risk adjustment models” defines the terms “risk assessment” and “risk adjustment” and provides overviews of the prominent risk assessment and risk adjustment models and their various uses, including profiling physicians and other health care professionals. Because numerous risk adjustment models have failed to predict valid practice efficiency rankings and/or health care expenditures, this resource concludes that risk adjustment systems that fail to accurately account for differences in the patient’s health status and the related costs of care should not be used to profile individual physicians. Currently, we are unaware of any systems that take into account all of the risk factors that should be considered when using risk adjustment to determine costs of care. A second resource, “Terminology used in physician profiling” helps physicians assess information they receive about physician profiling programs by defining common profiling terms used in health insurers’ physician profiling programs. Visit www.ama-assn.org/go/pfp to access these resources and many others on physician profiling.

AMA practice tip: Open access scheduling: Is it right for your practice?

The AMA has another resource as part of its continuing effort to help physician practices improve their patients' experiences. The member's only resource, "Open access scheduling: Could it improve your patients' experiences and your bottom line?", provides information on open access scheduling and the benefits and challenges associated with adopting this type of scheduling system.

Vist www.ama-assn.org/go/patientexperience to learn more about measuring patient satisfaction and improving your patients' experiences.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the MGMA collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the MGMA offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Evaluating business models—understand which alternative suits your practice best

Are you seeking ways to simplify your practice and reduce administrative overhead? The AMA’s Practice Management Center has created the educational resource “Cash practice alternatives: Considerations for physicians” to assist you in evaluating whether limiting your practice’s financial dependence upon health insurer contracts might be a viable option for your practice. This resource walks through the various cash practice alternatives and helps you assess which business model suits your practice’s particular situation best.

AMA practice tip: Establishing an internal collections policy for your practice

An important part of managing the physician practice is addressing outstanding patient balances and taking the necessary steps to receive that balance before sending the patient account to an outside collection agency. The AMA and the Ohio State Medical Association (OSMA) developed the educational resource “Internal collections in the physician practice.” This resource discusses the importance of collecting from the patient at the time of service and provides useful tips and recommended steps for implementing a collections policy. This resource also includes sample template letters and practice policies to assist in developing physician practice policies.

AMA practice tip: Connecting with your patients

Online medical consultations, also known as e-visits, present opportunities for growth and increased efficiency in the physician practice. To learn more about this new patient convenience and whether it’s right for your practice, access the educational resource “Online medical consultations: Connecting physicians with patients.”

AMA practice tip: Appointment scheduling and your bottom line  

Something as simple as appointment scheduling can help improve a physician practice’s bottom line. For example, gathering basic patient data at the time the appointment is scheduled allows for the verification of the patient’s health insurance information before a patient’s visit. Visit the AMA Practice Management Center to access the educational resource “Appointment scheduling to improve your bottom line.” Available to AMA members as a member benefit, this resource was developed by the AMA Practice Management Center and the Kentucky Medical Association.

AMA practice tip: Helping patients understand their payment responsibilities

Physicians and office staff are encouraged to involve and educate patients about medical treatment decisions, as well as payer payment policies and procedures. Industry trends indicate that both payers and employers are shifting more of the responsibility and cost of health care treatment and payment to the patient. In response to this shift, physicians and office staff need to consider proactively establishing or revising their practice’s payment and collection policies accordingly. Visit the AMA Practice Management Center to access educational resources, such as “Helping your patients understand their billing and payment responsibilities” and “Understanding your health insurance policy and payment practices.” These resources were developed by the AMA Practice Management Center and the Kentucky Medical Association.

AMA practice tip: Save money with credit card payments—shop around

One of the best ways to ensure receipt of your patients’ payment responsibility is to offer the option of credit and debit card transactions. Learn how to maximize the benefits of accepting credit and debit card payments by contracting with a payment processor that suits your practice’s specific needs and by recognizing how you can save on fees with your current processor. The AMA Practice Management Center has developed the educational resource, “Shopping for a credit or debit card merchant agreement: Guidelines for physicians,” to help you improve your practice’s bottom line.

AMA practice tip: Evaluating business models—understand which alternative suits your practice best

Are you seeking ways to simplify your practice and reduce administrative overhead? The AMA Practice Management Center has created the educational resource “Cash practice alternatives: Considerations for physicians” to assist you in evaluating whether limiting your practice’s financial dependence upon health insurer contracts might be a viable option for your practice. This resource walks through the various cash practice alternatives and helps you assess which business model suits your practice’s particular situation best.

AMA practice tip: Establishing an internal collections policy for your practice

An important part of managing the physician practice is addressing outstanding patient balances and taking the necessary steps to receive that balance before sending the patient account to an outside collection agency. The AMA and the Ohio State Medical Association (OSMA) developed the educational resource “Internal collections in the physician practice.” This resource discusses the importance of collecting from the patient at the time of service and provides useful tips and recommended steps for implementing a collections policy. This resource also includes sample template letters and practice policies to assist in developing physician practice policies.

AMA practice tip: Helping patients understand their payment responsibilities

Physicians and office staff are encouraged to involve and educate patients about medical treatment decisions, as well as payer payment policies and procedures. Industry trends indicate that both payers and employers are shifting more of the responsibility and cost of health care treatment and payment to the patient. In response to this shift, physicians and office staff need to consider proactively establishing or revising their practice’s payment and collection policies accordingly. Visit the AMA Practice Management Center to access educational resources, such as “Helping your patients understand their billing and payment responsibilities” and “Understanding your health insurance policy and payment practices.” These resources were developed by the AMA Practice Management Center and the Kentucky Medical Association.

AMA practice tip: Save money with credit card payments—shop around

One of the best ways to ensure receipt of your patients’ payment responsibility is to offer the option of credit and debit card transactions. Learn how to maximize the benefits of accepting credit and debit card payments by contracting with a payment processor that suits your practice’s specific needs and by recognizing how you can save on fees with your current processor. The AMA Practice Management Center has developed the educational resource, “Shopping for a credit or debit card merchant agreement: Guidelines for physicians,” to help you improve your practice’s bottom line.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and MGMA collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and MGMA offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and MGMA collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and MGMA offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Selecting a clearinghouse to process claims

Physicians and practice staff—are you considering selecting a clearinghouse to handle your practice’s claims process and submission functions? If so, you are encouraged to review the “What is a clearinghouse?” resource developed by the AMA Practice Management Center and the Kentucky Medical Association. Designed to educate physicians and practice staff about the clearinghouse function, this resource explains the nuances that relate to the submission and transmission of the physician practice’s claim information by an outside clearinghouse.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice

AMA practice tip: Collecting payment for services rendered

Collection services can play an integral role in helping physician practices improve cash flow by securing payment from hard-to-collect delinquent accounts. To offer physicians guidance in selecting a service, the AMA Practice Management Center has developed the resource “How to select a collection service.”

AMA practice tip: Save money with credit card payments—shop around

One of the best ways to ensure receipt of your patients’ payment responsibility is to offer the option of credit and debit card transactions. Learn how to maximize the benefits of accepting credit and debit card payments by contracting with a payment processor that suits your practice’s specific needs and by recognizing how you can save on fees with your current processor. The AMA Practice Management Center has developed the educational resource, “Shopping for a credit or debit card merchant agreement: Guidelines for physicians,” to help you improve your practice’s bottom line.

AMA practice tip: Take the mystery out of using modifier 59--Distinct Procedural Service

Correctly reporting modifier 59 can be a challenge even for the experienced coder, but doing so inappropriately puts your practice at risk. Reporting this modifier incorrectly could cause a compliance issue. Failing to append modifier 59 when appropriate may result in lost revenue. Recognize when and how to use modifier 59 correctly, to ensure that your practice accurately records the services it delivers—and is paid fairly for those services

Learn how to avoid compliance issues or lost revenue, with help from the AMA Practice Management Center's brief educational webinar, “Definitions and use of Modifier 59.”  In this 20-minute webinar, AMA experts Marie Mindeman, of CPT Coding and Regulatory Affairs, and Danielle Pavloski, of CPT Education and Information Services, review the proper and improper uses of modifier 59 to help you ensure correct coding.   

AMA practice tip: Definitions and use of modifier 25

Proper coding is critical to managing a practice’s claims revenue cycle. However, the complexity can also be daunting. Knowing when and how to use codes such as CPT^® modifier 25 ensures that your practice accurately records the services it delivers—and is paid fairly for those services

An archived instructional webinar from the AMA walks physicians and their staff through proper and improper uses of modifier 25. AMA experts in CPT coding also discuss answers to common questions about using this modifier and provide a checklist for evaluating whether its use is appropriate.

View the webinar, “Definitions and use of modifier 25” to learn more, and bookmark www.ama-assn.org/go/psa-webinars for access to additional webinars about practice management issues.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Access key payer information quickly and easily

Navigating the websites of health insurers to find a piece of information can be complex and tiresome. To ease this process, the  AMA has compiled a list of direct links to the most frequently-sought information for many major payers. Visit www.ama-assn.org/go/payerpolicies to access this resource and reduce the time you and your staff spend searching for answers.

AMA practice tip: Streamline claims processing with time-of-service payment

One effective way to simplify your claims process is to accept patient payments at the time of service. A collection of AMA resources can show you how. The AMA’s point-of-care pricing toolkit explains how to use newly available electronic patient-specific insurance eligibility information to notify your patients of their payment responsibility and accept payment at the time of service. Three archived webinars also guide physicians in implementing time-of-service payment as a standard part of the claims process. In addition, AMA members can access sample scripts (AMA login required) for practice staff to use in their interactions with patients to ensure they understand their payment options and the practice’s policies.

These resources are a part of the AMA’s “Heal the Claims Process”™ campaign, which aims to reduce the cost of managing the claims revenue cycle from as much as 14 percent of revenue to just 1 percent. Sign the campaign pledge to demonstrate your commitment to claims processing efficiencies.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Access key payer information quickly and easily

Navigating the websites of health insurers to find a piece of information can be complex and tiresome. To ease this process, the  AMA has compiled a list of direct links to the most frequently-sought information for many major payers. Visit www.ama-assn.org/go/payerpolicies to access this resource and reduce the time you and your staff spend searching for answers.

AMA practice tip: Preparing for health insurer retrospective audits

The AMA, with cooperation from the American Academy of Neurology, created the educational resource “How to prepare for a health insurer retrospective audit” to educate physicians and their practice staff about the recoupment efforts of health insurers through the retrospective audit process. Physician practices can use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit’s findings.

AMA practice tip: Performing an internal billing audit

The AMA, with cooperation from the American Academy of Neurology, developed the educational resource “How to perform a physician practice internal billing audit” to help physician practices understand both the need for an internal billing audit and how to perform an internal billing audit to yield improved claims management processes, cash flow, and compliance with applicable laws and regulations.

AMA practice tip: Establishing an internal collections policy for your practice

An important part of managing the physician practice is addressing outstanding patient balances and taking the necessary steps to receive that balance before sending the patient account to an outside collection agency. The AMA and the Ohio State Medical Association (OSMA) developed the educational resource “Internal collections in the physician practice.” This resource discusses the importance of collecting from the patient at the time of service and provides useful tips and recommended steps for implementing a collections policy. This resource also includes sample template letters and practice policies to assist in developing physician practice policies.

AMA practice tip: Who owns the data—the physician practice or the billing service?

The AMA, in collaboration with the Healthcare Billing and Management Association (HBMA), has developed the educational resource “Data ownership issues for the physician practice and medical billing service” to help physicians recognize the questions they should consider addressing prior to contracting with a billing service. This resource addresses topics such as data ownership and issues related to what happens when the relationship between the physician and billing service terminates. Physicians can use this informational resource when considering entering into an agreement with a billing service.

AMA practice tip: Improving practice efficiencies with electronic claims submissions

The AMA, in collaboration with the Connecticut State Medical Society, developed the educational resource “The benefits of electronic claims submission—improve practice efficiencies” to help physicians and their practice staff understand the electronic claim submission process and the many benefits that may be realized by submitting claims electronically to third-party payers. This resource discusses the reduction of claim submission costs and errors, and offers tips on getting started with electronic submission.

AMA practice tip: Selecting a clearinghouse to process claims  

Physicians and practice staff—are you considering selecting a clearinghouse to handle your practice’s claims process and submission functions? If so, you are encouraged to review the “What is a clearinghouse?” resource developed by the AMA Practice Management Center and the Kentucky Medical Association. Designed to educate physicians and practice staff about the clearinghouse function, this resource explains the nuances that relate to the submission and transmission of the physician practice’s claim information by an outside clearinghouse.

AMA practice tip: Defining a medical billing service

Before you consider working with one, it is important to know what a medical billing service is and what the service can do for your practice. A medical billing service may help physician practices save time and increase profitability by reducing billing expenses and increasing revenues. A good medical billing service also allows physician practices to concentrate on their patients while increasing their practice’s bottom line. Visit the AMA Practice Management Center Web site at www.ama-assn.org/go/pmc to access the educational resource “What is a medical billing service?” AMA members can download this educational resource as a member benefit.

AMA practice tip: Improve the health of your practice

The AMA “Heal the Claims Process”™ campaign focuses on reducing the administrative burden physician practices face to ensure accurate payment on claims, thereby increasing the resources and time physicians can devote to caring for their patients. As part of this campaign, the AMA has created the tool “Prescription for a healthier practice: Physician claims process check-up.” This checklist helps physicians examine their practice’s ability to analyze health insurer payments for accuracy and effectively address delays, denials and reductions in payment. Ensure your practice’s financial health to help create a supportive environment for enhanced patient care.

AMA practice tip: Establishing a cost-based practice fee schedule

The  AMA has developed the educational resource “Fee schedule analysis: Using your complete practice cost as a guide” to help physicians and their practice staff recognize the need to establish their practice fee schedule based on what it actually costs to provide a service rather than basing their fee schedule on what a third-party payer or other entity wants to pay. This resource includes a 12-step guide to help physician practices create their own unique physician practice fee schedule with an easy-to-complete spreadsheet that will allow physician practices to include additional markup percentages to account for profit, contributions to reserves and future capital expenditures.

AMA practice tip: Eliminating unfair discounts

Physicians are regularly solicited to participate in preferred provider networks (PPNs) via participating provider agreements. But how does a physician know if the agreement is beneficial for the practice? In today’s market of rental networks, it is imperative to understand which organizations physicians are contracting with and what the agreements should contain. View the webinar, “Eliminating unfair discounts” to learn how preferred provider networks work, what the difference is between a primary and secondary provider network and what should be contained in an agreement. This webinar also provides an update on the AMA’s related legislative activities.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Access key payer information quickly and easily

Navigating the websites of health insurers to find a piece of information can be complex and tiresome. To ease this process, the  AMA has compiled a list of direct links to the most frequently-sought information for many major payers. Visit www.ama-assn.org/go/payerpolicies to access this resource and reduce the time you and your staff spend searching for answers.

AMA practice tip: Claims submission, processing, adjudication and payment

The AMA developed the educational resource “Follow that claim” to provide physicians and their practice staff with an understanding of what happens to a claim once it leaves the practice. A claim is followed as it moves along the claims submission and health processing networks. Understanding this flow will enable physicians to better address the delay, denial and reduced payment tactics used by third-party payers.

AMA practice tip: Health plan payer’s claim edits and a physician’s bottom line

The AMA developed the educational resource “The effect a payer’s claim edits can have on the repricing and payment of your claim” to raise awareness of how a claim edit applied by a payer could affect the physician practice’s bottom line. This resource also highlights how a negotiated fee with a payer for a specific service performed does not necessarily translate into payment of that fee on a claim.

AMA practice tip: Losing revenue through inappropriate health insurer adjustments

The AMA developed the educational resource “Is your practice losing revenue through inappropriate health insurer adjustments?” to alert physician practices to the need to carefully review health insurer explanations of benefits in order to pinpoint and address underpayments based on inappropriate adjustments by the health insurer.

AMA practice tip: Streamline claims processing with time-of-service payment

One effective way to simplify your claims process is to accept patient payments at the time of service. A collection of AMA resources can show you how. The AMA’s point-of-care pricing toolkit explains how to use newly available electronic patient-specific insurance eligibility information to notify your patients of their payment responsibility and accept payment at the time of service. Three archived webinars also guide physicians in implementing time-of-service payment as a standard part of the claims process. In addition, AMA members can access sample scripts (AMA login required) for practice staff to use in their interactions with patients to ensure they understand their payment options and the practice’s policies.

AMA practice tip: Eliminating unfair discounts

Physicians are regularly solicited to participate in preferred provider networks (PPNs) via participating provider agreements. But how does a physician know if the agreement is beneficial for the practice? In today’s market of rental networks, it is imperative to understand which organizations physicians are contracting with and what the agreements should contain. View the webinar, “Eliminating unfair discounts” to learn how preferred provider networks work, what the difference is between a primary and secondary provider network and what should be contained in an agreement. This webinar also provides an update on the AMA’s related legislative activities.

AMA practice tip: Access key payer information quickly and easily

Navigating the websites of health insurers to find a piece of information can be complex and tiresome. To ease this process, the  AMA has compiled a list of direct links to the most frequently-sought information for many major payers. Visit www.ama-assn.org/go/payerpolicies to access this resource and reduce the time you and your staff spend searching for answers.

AMA practice tip: Improve the health of your practice

The AMA “Heal the Claims Process”™ campaign focuses on reducing the administrative burden physician practices face to ensure accurate payment on claims, thereby increasing the resources and time physicians can devote to caring for their patients. As part of this campaign, the AMA has created the tool “Prescription for a healthier practice: Physician claims process check-up.” This checklist helps physicians examine their practice’s ability to analyze health insurer payments for accuracy and effectively address delays, denials and reductions in payment. Ensure your practice’s financial health to help create a supportive environment for enhanced patient care.

AMA practice tip: Receive payment for your out-of-network services

Physicians’ ability to provide their communities with quality care is dependent on their ability to keep their practices financially viable. It is therefore important that physician practices pursue appropriate and fair payment that is consistent with legal and community standards for legitimate services provided. The  AMA Practice Management Center has developed the educational resource “Holding health insurers accountable for out-of-network services” to help physicians as they seek appropriate payment from health insurers that consider the physician out of network. This resource provides details about what out-of-network physicians might expect when dealing with the health insurer, how these physicians can stay informed about payment laws and issues, and how they can collect fair and accurate payment for their services.

AMA practice tip: Protecting your practice from inappropriate discounts

Multiple payers could be taking advantage of your lowest contracted payment rate through the use of a rental network preferred provider organization (PPO). The AMA developed the resource “Read your contracts: Is your practice losing revenue through rental network PPOs?” to educate physicians about how to identify and protect their practices from inappropriate discounts.

AMA practice tip: Making sense of rental network PPOs

Is one of your practice’s payers utilizing a rental network preferred provider organization (PPO)? These arrangements can be complicated and difficult to identify in advance, often depriving a practice of revenue unfairly. The  AMA has created the educational resource “The tangled web: the rental network PPO industry” to help physicians and their practice staff recognize and protect against payer discounting practices tied to the use of a rental PPO. The resource provides background information about this payment structure, as well as tips for ensuring that your practice avoids entering into unfavorable agreements which could cost you revenue.

AMA practice tip: Getting paid what you deserve for out-of-network treatment

The AMA has developed the educational resource “Out-of-network payment challenges for the physician practice” to provide physicians and their practice staff resources to understand a third-party payer’s obligation for payment to out-of-network providers. The resource explains some of the payment challenges that arise when a physician who is considered out of network requests payment from a patient and/or health insurer.

AMA practice tip: Experience savings with electronic funds transfer  

Want to save thousands of dollars per physician annually? Accepting electronic funds transfer (EFT) payments from health insurers and automating your payment process can help you experience significant savings and: 

• Speed up payment
• Save time spent on manual processes such as depositing paper checks and making phone calls to health insurers
• Reduce the risk of lost or stolen checks
• Free time for revenue-enhancing functions such as ensuring correct payment

The AMA’s new EFT Toolkit helps make the process of accepting EFT payments hassle-free. The toolkit outlines the steps to getting started, specific considerations for physician practices, and checklists of questions to ask your bank, health insurers, and your billing service or clearinghouse before signing an EFT agreement. The toolkit also provides an archived webinar with industry experts. Visit www.ama-assn.org/go/eft to access these free resources and start experiencing the savings in your practice.

AMA practice tip: Defining a medical billing service

Before you consider working with one, it is important to know what a medical billing service is and what the service can do for your practice. A medical billing service may help physician practices save time and increase profitability by reducing billing expenses and increasing revenues. A good medical billing service also allows physician practices to concentrate on their patients while increasing their practice’s bottom line. Visit the AMA Practice Management Center Web site at www.ama-assn.org/go/pmc to access the educational resource “What is a medical billing service?” AMA members can download this educational resource as a member benefit.

AMA practice tip: Collecting payment for services rendered

Collection services can play an integral role in helping physician practices improve cash flow by securing payment from hard-to-collect delinquent accounts. To offer physicians guidance in selecting a service, the AMA Practice Management Center has developed the resource “How to select a collection service.”

AMA practice tip: Frame your claims management correspondences accurately

Clear and precise communication is vital for a practice dealing with claims management matters. The  AMA has prepared a series of template letters which physicians and their practice staff may use as samples in a variety of common circumstances, such as notifying a health insurer of late payment, filing an appeal, or contacting a state insurance commissioner. In addition, AMA members may download, modify, and customize these templates for use in their practices. AMA members can also access the National Managed Care Contract Database in order to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Visit www.ama-assn.org/go/templateletters to access these resources.

AMA practice tip: Combating inappropriate health insurer claim denials

The AMA developed the educational resource “How to appeal inappropriate health insurer claim denials” to educate physicians and their practice staff about appealing erroneous payment reductions and denials. This resource also includes tips to assist physicians in identifying and appealing inappropriate health insurer claim denials.

AMA practice tip: Taking an active approach to the appeals process

The AMA developed the interactive resource “Appeal that claim” to simplify the claim audit and appeals processes for physicians and their practice staff. This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim.

AMA practice tip: Don't write off claim denials - fight for accurate payment

If your practice submits claims electronically, there's a free tool to help you secure accurate payment from health insurers for inappropriately denied claims.  With the Claims Workflow Assistant, a free online tool from the AMA Practice Management Center, you can look up the reasons health insurers reported for denying claims on the electronic remittance advices (ERAs) you receive.  Then, you can determine the best steps for your practice to reverse the denial.  The Claims Workflow Assistant provides numerous template appeal letters that AMA members can easily modify to use in their practices.  Visit the AMA Practice Management Center website at www.ama-assn.org/go/pmc to access the Claims Workflow Assistant.

AMA practice tip: Health plan payer’s claim edits and a physician’s bottom line

The AMA developed the educational resource “The effect a payer’s claim edits can have on the repricing and payment of your claim” to raise awareness of how a claim edit applied by a payer could affect the physician practice’s bottom line. This resource also highlights how a negotiated fee with a payer for a specific service performed does not necessarily translate into payment of that fee on a claim.

AMA practice tip: Losing revenue through inappropriate health insurer adjustments

The AMA developed the educational resource “Is your practice losing revenue through inappropriate health insurer adjustments?” to alert physician practices to the need to carefully review health insurer explanations of benefits in order to pinpoint and address underpayments based on inappropriate adjustments by the health insurer.

AMA practice tip: Preparing for health insurer retrospective audits

The AMA, with cooperation from the American Academy of Neurology, created the educational resource “How to prepare for a health insurer retrospective audit” to educate physicians and their practice staff about the recoupment efforts of health insurers through the retrospective audit process. Physician practices can use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit’s findings.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.

AMA practice tip: Taking an active approach to the claims management process

The AMA developed the educational resource “Prepare that claim” to help physician practices review the efficiency of their current internal claims management process. This booklet contains sample forms and policies that can be adapted to fit the specific needs of a physician practice.

AMA practice tip: Preparing for health insurer retrospective audits

The AMA, with cooperation from the American Academy of Neurology, created the educational resource “How to prepare for a health insurer retrospective audit” to educate physicians and their practice staff about the recoupment efforts of health insurers through the retrospective audit process. Physician practices can use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit’s findings.

AMA practice tip: Toolkit helps maximize practice efficiency in rapidly changing health care environment

The upcoming transition to the government’s modified electronic transaction standards, coupled with the Medicare and Medicaid electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software. To help you select and purchase the most appropriate software for your practice, the  AMA and the Medical Group Management Association (MGMA) collaborated to develop an online toolkit. Free to members of the AMA and the MGMA, the new “Selecting a Practice Management System” toolkit provides a roadmap to make this process easier for your practice. You can use this information to establish your practice needs and take advantage of recent improvements in automation. The toolkit resources include:

• A five-step guide to practice management system software selection.
• A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.
• A sample “request for proposal” that you can employ in your communications with practice management system software vendors.

Visit www.ama-assn.org/go/pmsoftware to start taking advantage of this valuable toolkit today.

AMA practice tip: Vendor directory helps you select a practice management system

Are you looking for a new practice management system or an upgraded system that can integrate with electronic health records? Get the information your practice needs to select the right software for your practice with the help of the new Practice Management System Software (PMSS) Vendor Directory.

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released “Selecting a Practice Management System” toolkit. Built on specific responses to survey questions posed to vendors, this directory can make your search for practice management system software easier. AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.

Visit www.ama-assn.org/go/pmsoftware to access the vendor directory and its related toolkit resources today.