By Bissan Biary, MHA, MMS Senior Practice Solutions Specialist
A representative of Ophthalmic Consultants of Boston meets with UnitedHealthcare.
Photo by Patricia Newton.
Following one-on-one meetings with health plan representatives arranged by the MMS this fall, two-thirds of physician and staff attendees reported that they expected to recoup revenues. The same proportion said their difficulties with those payers had been resolved. At this year’s Individual Claims Consultation (ICC) Days, physicians and staff from practices statewide had exclusive opportunities to meet with health plan representatives and adjudicate troublesome claims.
Managing a practice revenue cycle requires staff to interact with numerous payers and navigate a complex system of laws, regulations, and guidelines. The annual trio of in-person ICC sessions are designed by the Society and its district offices to help our physicians deal with their specific insurance-related issues and achieve the best financial outcomes.
The ICC events, at three locations statewide, allowed MMS member physicians and their staff to meet with representatives from major health plans.
This year the sessions were attended by over 30 practices ranging in size from several physicians to more than 1,000. About a third of the practices were primary care; the most well-represented specialties were orthopedics, multispecialty, cardiology, and ophthalmology.
Most attendees came to the sessions with a specific set of issues. Recurring problems included coordination of benefits, services not covered, and modifiers. Practices were also grappling with timely filing, medical necessity, patient coverage, and medical records. In addition, some practices were able to resolve claims denied in error, problems credentialing a new provider, eligibility and coding issues, and missing claims. The ICC Days are organized by MMS Practice Solutions and Medical Economics.
For help with your revenue cycle issues, contact Bissan Biary at bbiary@mms.org.
