The Smart Medical Practice

Expert Interview: Marchelle Cagle of caglecpc.com on Medical Billing



Expert Interview: Marchelle Cagle of caglecpc.com on Medical Billing
Marchelle Cagle, of Cagle Medical Consulting, is a health consultant who has written many articles and blogs in the areas of coding and billing.

We recently asked for Marchelle’s insight on medical billing – here’s what she shared:

Tell us your story. How did you get into medical billing? What services do you offer today?

I started working in medical billing and coding over 20 years ago. One of my first jobs was with a medical billing company. Today I am a consultant specializing in the areas of coding, billing, revenue cycle and education.

As an AAPC license instructor, I offer the Certified Professional Coding and Billing courses. I believe if we have more knowledgeable people in the field with billing and coding maybe we can help the overspending and waste when it comes to the healthcare systems.

What are the major challenges facing practices today with Revenue Cycle Management?

The challenges medical practices are facing today with concern toward billing and revenue are keeping revenue and income up in spite of reduced fee schedules. Thirty percent to 50 percent of the collections now are the patient’s portion, so ensuring that the patient’s portion is collected at time of service or prior to a procedure can be challenging.

One reason for these challenges is that the affordable health care act has created more insurance plans through the marketplace with high deductibles and out-of-pocket cost. It can also be challenging to understand the plans that did not comply with the affordable health care act and, for example, some plans may not offer preventive services, this can be quite confusing to staff and patients.

How do you approach training your clients on coding?

Improving the coding and billing process must come with continual education and strong communication between the physicians, coders and billing staff.

I like to teach my clients with real-world examples and scenarios they can relate to within their own specialties. Also, teaching my clients how to fully utilize tools that are readily available to them. For example, if you’re a general surgery office you need to understand bundling and un-bundling. So you need to understand the Correct Coding Initiative (CCI) edits to make sure that the appropriate reimbursement is gained.

What should all practices be doing to improve their coding? What advice do you find yourself repeating to clients over and over?

Automation is great and can save offices so much time so they can spend more time on patient care.

Today, I am focused more than ever on physician documentation and ICD-10 CM coding. We are moving toward a quality-based payment system and it is so very important to paint the picture of the patient’s care accurately through CPT and ICD-10 CM coding.

What predictions do you have for the future of revenue cycle management? How will the field evolve?

As far as predictions for the future of revenue cycle, it’s hard to say because things can change so rapidly. I do think that understanding how to use data analytics and reporting that affects quality measures and revenue is crucial in the future of healthcare. Physician practices must understand how they are perceived by the patient population, insurance payers and other systems that track quality.

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