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March 2022

Professional Coding Corner 

Brought to you by PPR 


They’re among the questions that keep medical practice managers up at night: How can we negotiate successful payer contracts? How can we obtain prior authorization more easily? How can we ensure accurate coding for telehealth and COVID-19-related services? What about staffing challenges? Do we have enough staff? How can we retain existing staff and recruit high-quality talent in the future?  


As we look ahead, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. In the meantime, check out these four newsworthy stories we’ve compiled this month. Most importantly, stay safe out there.  


Sharpen payer contract negotiation skills to increase reimbursement 

The American Medical Association (AMA) recently published several resources to help medical practices negotiate successful payer contracts. Other strategies? Consider joining an Accountable Care Organization (ACO). Be sure to check out this webinar about one rural physician who joined an ACO to remain both independent and profitable. 


Tackle prior authorizations once and for all 

Seventy-nine percent of practices say that prior authorization requirements have increased over the past 12 months, according to a recent survey. How can medical practices speed up prior authorizations? Some strategies that come to mind include: Sign up for payer newsletters to stay abreast of new and evolving requirements, create a master list of procedures and medications that require prior authorization, follow up regularly with payers, and optimize workflows to track prior authorization requests. What works best for you in your medical practice? 


Be prepared for crackdowns on telehealth fraud 

This recent article published by Medscape highlights several potential areas of telehealth fraud: Billing for more services than were actually provided, billing for services that were not provided, or inappropriately upcoding services. However, telehealth doesn’t seem to be going away anytime soon. It played—and continues to play—an important role in meeting mental health needs during COVID-19. It was also critical for Medicare beneficiaries during the first year of the pandemic. Audio-only telehealth visits are particularly important for community health centers in rural areas. What is your plan to ensure compliant documentation, coding, and billing for telehealth services? 


Medical practices continue to face staffing shortages 

A recent survey found that healthcare financial leaders continue to struggle with vacancies for these two positions: Registrars and billing specialists. Other in-demand positions include patient follow up, front office staff, central scheduling, denial specialists, authorization staff, claims specialists, and collections staff. Does your medical practice or critical access hospital experience these same challenges? If so, Physician Practice Resources can help. 


About us 

Physician Practice Resources, Inc., founded in 2002 and headquartered in Midlothian, IL, is a full-service company that partners with small and large healthcare organizations to build solutions that enhance operational effectiveness, improve clinical documentation, and decrease overall compliance related risks. Contact us at https://www.ppr-corp.com/about-ppr-corp/ for more information. 



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