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Increased Reimbursement For Primary Care Physicians, A Closer Look !

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A welcome respite for primary care physicians !

Everybody knows that primary care physicians are struggling to stay in business. A mandate by the Affordable Care act has announced that Medicaid rates for certain primary care procedures will be paid on par with Medicare rates.

 To receive additional reimbursement physicians will have to fill out, a, state specific Medicaid self-attestation form.

Medicare

Who are covered ?

Family practices, pediatricians and general internal medicine physicians are eligible for increased reimbursement. So are several other sub-specialties and physicians who perform high levels of primary care services. The major criteria are that, physicians should be board certified and have a billing history that indicates that about 60% of their billing is for primary care codes.

The rate increase will be in effect till the end of 2014. Physicians, who’ve registered through MITS and are approved by the Office of Medical Assistance, can see more digits in their pay check from April 2013.

The code to more dollars !

Primary care physicians will be reimbursed in accordance to HCPCS codes related to primary care. Evaluation and management codes from 99201 through 99499 are eligible, as are certain vaccine administration codes.

The rough and tumble of practicing primary care…

Primary care physicians are working under heavy financial pressure. The sequestration cuts of 2013 have taken a heavy toll on medical practices. The sustainable growth rate formula has quickly turned in to a nightmare for physicians.

 Reimbursement cuts, operational pressures and complicated regulations scared the daylights out of physicians.

Quite arguably it was primary care practices that were the hardest hit. Primary care centers were soon shutting their doors as it became increasingly difficult to practice. Primary care practitioners were finding it almost unfeasible to take care of their elderly Medicare patients.

At a time when it was needed the most !

The increase in reimbursement has come at a time when physicians need it the most. The increased Medicaid reimbursement means physicians are offered a reprieve after all the financial pressures they’ve gone to.

Want a few tips to increase the revenue of primary care practices ?

Patients Are Thronging Urgent Care Centers. Can Physicians Manage ?

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Are Your Patients Waiting Forever To Meet You ? 

Urgent care centers are sprouting all across the country. Recent studies indicate that urgent care centers have doubled over the last couple of years. As the healthcare industry undergoes major changes, cost cutting seems to be the new mantra.

Everybody is urging everybody else to cut down on costs. The latest to join the list are patients. Insurers are now insisting that patients explore more affordable options. Rushing to the ED for relatively minor ailments is not an option anymore. And patients are instead making a beeline to urgent care centers to reduce costs.

urgent-care

Is The Decline Of Primary Care Facilities A Reason ?

 Every healthcare news article in recent times has moaned the death of primary care centers. The shortage of primary care doctors only worsens by the day. The United States is reportedly short of over 9000 primary care doctors. By 2025 there will be a massive shortage of about 65,000 primary care doctors.

Urgent care centers offer the same medical services that primary care centers provide for acute care patients. This has led to a sharp increase in the demand for urgent care physicians.

40 Million Newly Insured Patients A Huge Driver !

There are going to be startlingly more patients waiting to meet the doc. The boom in urgent care centers can help thousands of patients meet their doctor on time. Hospitals are stepping up the plate to cash in on the demand for urgent care billing services. A lot many doctors have also started urgent care practices to cater to the huge influx of patients.

Too Much Of A Good Thing…

As the old maxim goes, too much of a good thing can be a bad thing. Physicians can, buoyed by the popularity of urgent care, bite of more than they can chew, inadvertently. Medical practitioners need to redesign their practices to handle patient demand.

Here is what urgent care centers can do to handle patient load :

  • Leverage physician extenders: Nurse practitioners can give tired doctors the respite they need. Instead of being at loggerheads with NPs, physicians need to work closer with urgent care NPs and leverage their potential, to ensure better patient care.
  • Have a smart patient portal: Patient portals can help automate tasks that will otherwise need an army of professionals to handle. Appointment scheduling, eligibility verification and most other front desk tasks can be automated to avoid long wait queues and flustered front office tasks.
  • Outsourcing billing and coding needs: More patients mean more claims to be transacted. Ass your claim traffic increases you’d need additional staff to manage huge billing volumes. You’d have to invest more on infrastructure and operational costs. Outsourcing can help urgent care centers contain costs and yet manage the vast number of patients waiting to be seen !

Are Meaningful Use Guidelines Driving Physicians Round The Bend ?

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Are physicians being rushed towards achieving MU ?

According to some strange law in the healthcare universe, there is always going to be someone complaining. EHR adoption rates are up. But before, you feel that doctors have finally made peace with their ehrs. Recent studies indicate that switching to an EHR can lead to loss of revenue.

Research Speak !

A recent study by the University of Michigan shows that only 27% of practices have showed a positive return on the money invested in their EHR.  It cites rather alarmingly, that a physician loses $43,743 over 5 years after EHR adoption.

The research further reveals that the incentives for working with an EHR do help. But in a “very uneven way”

MU

Rushing headlong into EHR adoption can be the reason…

The rapid pace of adopting EHR’s, in the pell-mell to receive incentives, is being blamed for the loss of revenue. EHR adoption rates are increasing at breakneck speed leaving no time for data collection to catch up. It paints a very unhealthy picture. In the race to ace the EHR game, patients it is feared, can be left in the lurch.

Can Stage 3 of Meaningful Use turn out to be a nightmare ?

This seems to be the shared fear of everyone, from the AMA Executive Vice President and CEO James L. Madara. To, the small practice owner, three blocks away. Stage Three MU has additional and stricter measures, for physicians to meet.

Inter-operability continues to be a key issue. With serious flaws in EHR systems and their architecture, MU can prove to be a disaster waiting to happen.

There is reason to chin up !

Though, loss of revenue due to EHR implementation continues to be a haunting dream. Physicians can take heart in the fact that focusing on their revenue cycle maximization that can reverse their fortunes.

The study by the University of Michigan on EHR use, has found that the major difference between practices that lost money, and those that didn’t. Was, how they used their EHR’s, to increase revenue.

Medical practices that, concentrated on patient care, improved their billing process and focused on reducing denied claims, saw a positive change. It is time for medical offices to not just concentrate on achieving MU but also think of ways to improve their billing cycle.

Want To Save $ 23,000 ? Switching To E-Billing Will Improve Your Practice’s Financial Health

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Still Stuck With Paper ?

What is your carbon footprint ? If you are still sending out paper claims, you are felling more trees. Agreed, this is an argument that is as old as fossils. Apart from saving trees there are a lot more advantages to using e bills ! It helps to track claims easily and lessens the amount of time your insurer takes to sign your check.

ebilling-infographic

Save More Dollars !

According to the American Medical Association submitting claims electronically can save a practice 55% of its claims submission costs. The AMA further states that physicians stand to gain above 23,000 dollars a year by switching to electronic claims.

Electronic billing also reduces the TAT of insurers. The overall efficiency and cost effectiveness of the process is just what overworked medical practitioners need. Paper claims are time consuming to generate, transmit, and maintain a record of. Electronic bills are quite simply put, the smarter way to bill !

Joining The e-club !

According to a recent survey of America’s health insurance plans the usage of billing electronically has doubled. From a measly 44% in 2002 to 94% in 2012 there’s been an exponential increase in providers who are switching to e billing.

Almost 79% of claims are now automatically adjudicated without manual support. Physicians are finding e billing helpful as it helps their staff to focus on patient engagement.

A Huge Relief For Billers…

What is the biggest headache of a medical biller ? No. It is not getting claims paid. The bigger headache is finding out which claim is in what stage of processing. An average medical office sends out dozens of claims per day. Keeping tabs on each one of them can trip up the most determined of medical billers.

ERA’s and EFT’s help medical billers to hasten the pace of the billing process. And make it easier for them to maintain a clear cut billing record.

Ask Your Insurer To Move On From The Stone Ages !

It is time for insurance companies to stop working with paper claims. Physicians need to put their foot down and ask insurers to accept electronic claims! Concerted and continuous effort across the continuum will ensure that the healthcare industry functions a lot more smoothly and efficiently. And yes, save a billion trees in the process !

Is Your Medical Practice Ready To Attest For Meaningful use?

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Are You Ready To Attest For Meaningful Use ?

If you are an EP, receiving the MU incentive check is going to top your list of priorities. It is time for physicians to pull up their socks and start working towards meeting the eligibility criteria for MU 2. Before getting down to the brass tacks it is important that you phase out the attestation process.

Meaningful Use

Being Up To Speed On Data Transmission…

Data transmission is a tricky word. It means you need to share data without making compromises on data privacy. To, begin with exchange a clinical document with one of your peers who use a, different EHR. Send out “trial” documents to test the waters. Check whether you are able to transmit clinical data securely.

Shop for a HIE and team up with one, to be able to transmit medical data easily across the care continuum.

Time To Stop Fighting Over Turf  !

Physicians have always felt a little queasy about letting patients access their EHR. A secure patient portal that allows patients to view and download medical information is important to meet the patient engagement criteria.

It is essential that stringent authorization methods are followed to prevent data misuse. And that, patients, are sufficiently educated about data security.

Dial Your Vendor’s Number…

You’ve pulled out all stops to make sure your practice meets MU standards. But is it is of little or no use, if your vendor doesn’t match your pace. Check with your vendor whether your EHR is compliant with the Meaningful Use 2 guidelines. Communicate with your EHR vendor and emphasize that a specific timeline needs to be adhered to.

With data interoperability being one of the key considerations, to attest for MU, it is important that you join forces with your EHR vendor, to reach the finishing line on time.

Have you spoken to your business associates ?

It is important that your business associates are an integral part of your MU attestation efforts. Whip up a plan with your business associates to optimize your workflow and streamline your everyday work processes.

2 hours a day !

Spending as little as two hours a day to work towards achieving MU can put you on the fast track to receiving your check. The key is to coordinate. Make sure that everybody who is involved with your medical practice is on the same boat. And to, make the most important person in the equation, your patients, to get more actively involved.

Should Patients Be Allowed To Access Their Physicians EHRs? Weighing The Pros And Cons

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Whose EHR Is It Anyway ? !

 This far and no further, is the approach physicians are taking when it comes to patient EHR access. Patient electronic access is an important objective of Meaningful Use. It can help physicians to deliver better quality of care.  And to bring everybody across the care continuum in one single, secure platform.

EHR-access

Data security risks is the key reason why the debate on patients access to EHR is still up in the air. Nothing can scare physicians more than a data breach. The average housewife in New Jersey may not be up to date on HIPAA regulations  And there is also the potential threat of patients misinterpreting their medical data.

A physicians understanding of a medical problem is not the same as that of a patients. It could cause unnecessary stress and anguish, and make patients vulnerable to self-medication dangers.

I Don’t Want My Patients In The Drivers Seat…

According to a recent survey conducted by Accenture, around 65% of doctors feel that patients should be given limited access. About 82% of physicians endorse the view that patients should be actively involved in their healthcare. Around 4% of doctors told they’d like to ban patients from having an online access to medical records.

Most physicians were of the opinion that other than demographics, patients shouldn’t be allowed to edit or update any other medical data.

The Way Around This Catch 22 situation !

  • Talk to your EHR vendor about including patient identity proofing and authentication features.
  • Standardize the information you want your patients to access.
  • Educate your patients about your EHR.
  • Work with a  biller who has experience in working with your EHR so patient billing is streamlined to a great extent
  • Follow a clear cut privacy policy and usage guidelines.

Will Doctors Fade Into Oblivion? The Survival Guide For Newyork Physicians !

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Can I Meet A Physician ?

The answer would most probably be “no” in a few years time. It is going to get increasingly hard to find a physician in New York. The State University of New York center (SUNY) has predicted that there will be severe physician shortage in New York by 2030. The study further reveals that the average age of physicians in New York is alarmingly high.

Medical-Billing-Newyork

I Have An Insurance Number, But Not Medical Care…

The huge physician deficit can leave millions of newly insured patients, under Obama-care  have insurance numbers. But it is no guarantee they will get to meet a doctor. The physician workforce is slowly dwindling and finding a doctor can be the biggest challenge, in the years to come.

The problem is steadily getting worse and it is not just the healthcare law that is to be blamed. Proprietary and complicated EHRs and ambiguous reimbursement models are driving physicians out of the business.

84% Docs Feel The Profession Is In Decline !

And nearly 60% wouldn’t recommend medicine as a career choice. About 75% of physicians feel they are being overworked. These are just a few worrying markers of the disillusioning climate the healthcare industry is in.

Doctors Across New York ; The Much Needed Relief For Physicians !

The DANY program offers physicians based in New York the life support they need. It offers physician practice support, physician loan repayment and help for facilities that recruit new doctors. The application process has also been streamlined to help practices based in NY meet the financial pressures they’re under.

Large health plans are also working in tandem with local medical practices and community health centers to bring in more primary care doctors.

Joining Forces…

Nurse practitioners can fill in the void by offering primary care to patients. Physicians and NPs instead of being at loggerheads, can work together to provide better care for patients across the state. As the shortage worsens team based care will act as the most effective solution.

Outsourcing documentation and billing needs will also offer harried Newyork physicians a brief respite in an otherwise blistering healthcare climate !

The Face-Off Between Doctors And Nurse Practitioners!

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Working, without someone looking over our shoulder, is a secret wish of all of us. And that has led to one of the most heated debates in the healthcare industry. Coming, close on the heels, of the battle between, CRNAs, and, anesthesiologists. It is now physicians and nurse practitioners who are at loggerheads.

Endangering patients…

Physicians fear that working without their supervision can put patients at risk. And lead to fragmented, patchy patient data. Providing longitudinal care and unifying diverse factors across the care continuum is an ongoing challenge. Nurse practitioners functioning independently can lead to increased confusion, is the chief complaint of docs.

It is a known fact that recent regulations and compliance thresholds have put physicians under a lot of stress. To have nurse practitioners challenge their role in the medical fraternity. And compete for patients, is the last thing physicians need.

Nurse-practitioner

End the monopoly !

Do we know how to bill for services ? Yes.

 Do we know how to take care of patients in need of primary care ? Yes.

Do we need a physician to tell us what to do ? No.

This is the war cry of America’s nurse practitioners. They feel practicing under the supervision of physicians is unnecessary and restrictive. Despite being highly qualified and experienced, nurse practitioners feel they are being given a rough deal.

Not a turf war for money !

The request by NP’s to reduce physician interference can surprisingly prove to be beneficial. Obama care is going to result in a sudden influx of thousands of patients. As United States battles severe primary care physician shortage. Qualified nurse practitioners and a newer model of working might just be the right solution.

Once the dust settles down…

It is being hoped that once the storm settles down it will bring a lasting and mutually agreeable solution. The need of the hour is clear cut billing regulations. Reformed, payer policies, that don’t leave room for doubt. And, nurse practitioners and physicians, who work together towards a sustainable solution.

As a nurse practitioner there is enough on your plate already ! Here is the presentation on “Reimbursements guide for nurse practitioners to survive the storms in 2013 !”

Ten Tips For Surgery Centers To Pump In More Greens!

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surgery-centers

There you go ! Another rejected claim. Well, running a surgery center billing practice can be demanding, expensive, and on a bad week, thankless! With, surgery centers constantly battling with payers, and, patients who have no idea what their financial liabilities, are. It can be an uphill climb on a snowy day, to get paid !

Here is how you can fight those financial demons and come out at the other end a winner ! And also ensure your clinical documentation is never short of perfect !

10 ways to increase the revenue of your surgery center…

  1. Encourage your surgeons on-board to have a financial stake in your surgery center to avoid losing out on case load.
  2. Create a better atmosphere to work by upgrading to better systems and work processes to attract and retain a strong physician base.
  3. Collect copay’s and deductibles at the front-desk and have multiple payment options.
  4. Compare your staff members’ cost per case with your competitors, and how reimbursement varies across different specialties. Analyze and set benchmarks.
  5. Follow a rigorous claims follow up process and fight denied claims as soon as they reach your table, to increase the revenue and valuation of your center.
  6. Physician documentation plays an important role. Surgeons should dictate clearly, name the procedure. And ensure details and events are sequenced in the operative note.
  7. Don’t put off renegotiating with your insurer. If you put off renegotiating year after year there are little chances of your insurer ever giving you a reimbursement hike !
  8. Collect and verify patient information during the pre-registration stage to avoid fall outs.
  9. Call your patients prior to their appointment and inform them about their financial liabilities.
  10. Have a quick sheet that includes pertinent questions, such as, how many surgeries were performed, the number of co-surgeons etc for physicians to fill out after a surgery.

28 Million Dollar Fine,Prevent Your Practice From Being Booked Under The False Claims Act

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False Claims And A 28 Million Dollar Lawsuit !

false-claims-act

False claims, data breaches and billing errors happen to others right ? ! No. It can happen to your practice, despite your efforts and best intentions. Don’t wait for a watershed moment to catch you unawares and throw you off the course. Federal regulations are becoming stricter, and the penalties and punishments for fraud and abuse allegations, are more unforgiving.

28 Million Dollar Fine For Fraudulent Billing…

Even as this blog is being written a nursing home based in Illinois has been booked for charges against the false claims act. Two ex employees filed a case against the nursing home for providing inadequate care. And, sending, multiple fraudulent claims to insurance companies. The hospital was penalized for offering useless services and more than 19 million dollars for filing false claims.

The employees were awarded more than 400,000 dollars for bringing to light the billing malpractices of the nursing home.

What Is A False Claim ?

There are physicians who end up with summons for faults they were not even aware of. To safeguard your medical practice from false claims you must first be aware of what constitutes a false claim.

  • Submitting an unbundled claim when the claim could have been bundled and submitted as a whole.
  • Up coding a medical service.
  • Billing for medically unnecessary services.
  • Increasing time units or any units of services for acquiring more reimbursement.
  • Submitting secondary claims that have to be sent to a different insurer, to the primary insurer.
  • Inflating patient care costs.
  • Copy pasting records in the EHR can lead to duplication of claims content.
  • Making use of automated coding tools and claim edits can lead to over-billing errors.

Tips To Safeguard Your Practice From Being Booked Under The False Claims Act !

  • Ensure your claims are, bundled/unbundled appropriately. If you are not too sure pick up the phone and discuss with your insurer.
  • Always provide additional documentation substantiating the medical necessity of a treatment prior to transmitting a claim.
  • Document facts such as time units, complexity of a medical decision and gravity of a wound, always.
  • Communicate with your patients and explain about patient liabilities.
  • Submit primary and claims appropriately.
  • Avoid copy pasting billing details in your EHR as it creates “cloned” notes.
  • Review and update information in your EHR constantly.
  • Finally, make use of the features your EHR offers but don’t rely on them completely.