Medical Billing Services | Medical Billing Company Checklist - Page 7 of 13

Infographics: EMR Implementation At Cross-Roads

September 3, 2013 by Ango Mark Leave a Comment

EMR, a Marriage that has to succeed :

Healthcare providers in the US have opted for EMR as mandated by the federal government, for superior patient care and efficiency,with reduction in costs and enhancement of patient experience. However, the biggest hurdle, namely getting it to work efficiently, is not yet crossed.

Thorny path where benefits galore :

Implementation of an EMR system involves treading on a thorny transition path from paper-based to computer-based on-line live medical practice. However, once successfully implemented, improved efficiency, speed and accuracy of performing clinical tasks render the EMR systems an invaluable investment. It also promises to reduce clinician workload and medical errors.

The EMR Carrot :

Incentive payments of up to $27 billion for EMR implementation, or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible health care professional, are offered by Centres for Medicare and Medicaid Services (CMS). As of July 2013, more than 316,000 health care providers received incentive payment, according to CMS. According to the Robert Wood Johnson Foundation, the number of hospitals with EMR increased to 44 % in 2012, up by 17 % from 2011.

On the flip side,survey results depicta gloomy picture with yet to be realised EMR promises.

1. Based upon American EMR data collected from 2010 to 2012, user satisfaction levels with EMRs are dropping. These findings were presented at Healthcare Information and Management Systems Society (HIMSS) conference on March 5, 2013.
2. Overall EMR user satisfaction surveys revealed a 12% drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10% for the same period.
3. Dissatisfaction with EMR implementation is increasing regardless of practice type or EMR system, asserts Michael Barr, MD, ofAmerican College of Physicians’ (ACP’s) .
4. 50% of EMR implementations failed according to the National Coordinator for Health IT
5. Ohio-based StreamlineMDasserts that only 27% of EMRs are successful.
6. Yes and No! A recent survey of 17,000 EMR users revealed that nephrology (88%), urology (85%) and ophthalmology (80%) practices expressed the highest rates of discontent with their EMRs, while internal medicine (89%), family practice (85%), general practice (82%) and paediatrics (80%) specialists experienced highest rates of satisfaction with their EMRs.

Reasons for the impasse: Lack of effective end user physician training in EMR is the bane across the US healthcare industry. Importance of training has been overlooked and under-estimated by physicians.Richard Stokes, director of sales for Network 1 Consulting, warns that continued inadequate training of physicians will slow down the EMR system implementation.

Way out of the doldrums: Need of the hour is effective EMR training that involves 8 important issues :

1. Tailoring the EMR training sessions specific to the hospital/clinic.
2. Using experienced and certified EMR trainers
3. One-on-one training: Every physician has a different learning curve. Hence, having one-on-one training is a must. For smaller practices that may not have advanced IT background, physicians should be made to initially work side-by-side with experienced trainers.
4. EMR training for everyday workflow: Training needs to bescheduled around normal physician practice workflow. The physicians should be made to use EMR consistently in the manner they’ll need towork after going-live.
5. Basic skills and practice procedures: Many physicians are not even familiar with intricacies of computer usage. They have to be familiarised with basic computer skills.
6. Train, retrain and retrain: Training never ends and is a true ally.Training patiently, retraining, and on-going training hold the key for success, adds Susan Miller, administrator at Family Practice Associates of Kentucky. Leann DiDomenico, administrative director of Performance Paediatrics, uses EMR training videos and makes the physicians repeatedly carry out their tasks on the EMR, until they are confident of performing on their own.
7. Avoiding rushed training sessions.
8. Continuous evaluation of on-going training.

Helping hand from MedicalBillingStar :

Hospitals and clinics in the US can bank on MedicalBillingStar as their EHR trusted partner to help train physicians in nuances of EMR implementation and functioning.Tailor-made EMR training modules are available to cater to the specifics of any clinic/hospital. Training options include formal training during office hours or in special sessions outside of normal business hours, offsite training, and online training.MedicalBillingStar has the resources to help in training doctors, so that they can catalyse successful EMR adoption.

7 Salubrious Coding Tactics to Thwart Claim Denials

August 28, 2013 by Ango Mark Leave a Comment

Evolving code sets in varied coding systems (ICD-10-CM/PCS, CPT-4, HCPCS Level II, etc.) are creating an intricate, but beneficial platform for the patient care, clinical documentation, data transfer, research, practice analysis and also repayment. Despite this pragmatism, quite a lot of physicians don’t recognize the significance of coding in clinical practice and its impact on reimbursement.

The Tactics to Beat Around the Bush :

Beyond a shadow of a doubt, coding is the backbone of the practice business. Improper medical coding cause claim denialsand culminate ultimately in revenue loss. Thus, it is imperative to address the hardships in medical coding with a fresh pair of eyes.

1. Update to Upsurge : Once the new codes are released, every practice must update their encounter forms, super bills, user guidelines and EHR/PMS systems with the fresh codes to create clean claims and to zero down the denials.

2. Revise to Revive : During every ‘updated codes’ release, revise the corresponding fee schedule up-to-date, so as to improve your bottom line and to achieve compliance.

3. Educate to Excel : Apart from updating the tools and systems, it is indispensable to educate the physician and the coders with the fresh and revised codes and the records desirable to make the codes evident.

4. Check to Cheer: Although, the claim scrubbers effectively validate claims – by recognizing billing errors and creating edits to scrutinize denial issues – a manual check could ensure submission of clean claims. For example, the scrubbers may fail to validate the modifiers even though the software flags the claim as “modifier inappropriate”.

5. Review to Revamp : It is essential to review the new payment policies and coding guidelines constantly, to get acquainted with the payer’s regulations.

A. CPT^®: The American Medical Association’s (AMA’s) revised CPT^® codes can be effortlessly recognized. The green text in the CPT^® code book highlights the modifications that are new to the revised book. Sometimes, the guidelines will modify or add supplementary information for proper codes although the codes remain unchanged.

B. NCD/LCD : Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) can be reviewed through the Centers for Medicare and Medicaid Services’ (CMS’) website. More to the point, the revised payment policies of private insurance companies can be reviewed through the payer’s website. Reviewing the policies in this fashion aids the coders to – elucidate code use – spot the diagnoses that call for medical necessity – offer documentation requirements.

C. NCCI : The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services can be reviewed to understand the bundling of codes. Supplementations and revisions to the policy manual have been italicized in red font in the electronic copy.

6. Designate to Delight : It is unfair that most physicians don’t designate the primary diagnosis among an array of multiple diagnoses performed on the same patient. Furthermore, the physicians must number the diagnoses in the order of their significance so as to evade the denials based on ‘medical necessity’.

7. Invent to Infer : Following the aforesaid steps will assist you thwart claim denials associated with code revisions but will not eradicate them utterly, making “denial resolution” obligatory. All the perfectly created codes would not get you the repayment. For instance, one of the new complex chronic care coordination (CCCC) code – 99488 is not reimbursed by Medicare as per its policy guidelines and thus it will be denied. But, on another edge, a secondary or other insurance payer may reimburse for this code. Thus, you need to invent a procedure so as to deduce the non-covered codes for every payer in your network.

To know more about the coding tactics or to clinch a deal !

Contact MedicalBillingStar @ 1-877-272-1572

Infographics: Wriggling Out Of Problematic Emergency Medicine Coding Nightmares

August 20, 2013 by Ango Mark Leave a Comment

In today’s healthcare scenario,Emergency medicine (EM) practice have assumed enormous importance due to ever-increasing natural as well as man-made disasters, not to speak of acute health problems created by changing lifestyle and fast-spaced competitive environment. Few people appreciate the importance of emergency medical services until they are the ones having an emergency.

The EM Practice Fact Box :

1. Heavy Patient influx !EM services have emerged as the gateway for hospitals, and account for more than 50% of hospital admissions in the US.
2. According to the US Health Directorate, there was a spike in the number of patients who were seen in first 10 minutes (wait time) in 2012 (23.5%)as compared against 2009 (18.62%).
3. Thought-provoking !Every year, around 300,000 persons in the US experience an out-of-hospital cardiac arrest (OHCA), and approximately 92% of these die, according to Centres for Disease Control and Prevention (CDC).
4. Food for Thought !The majority of persons who experience an OHCA event do not receive cardiopulmonary resuscitation (CPR) or other timely interventions.
5. Revenue Potential !According to OIG (Office of Inspector General, US Department of Health & Social Services) between 2001 and 2010, Medicare payments for EM services increased by 48%, from more than $22 billion to more than $33 billion.
6. A surprise ! In a survey of Emergency Medical Services (EMS) leaders in the 200 largest American cities, the Journal of Emergency Medical Services found that 44 % of the areas surveyed had made budget cuts to emergency response services in 2012.

Against this back drop, it is not surprising that overworked EM physicians are unable to keep abreast of the constantly evolving and changing clinical codes and related modifiers. This situation is further aggravated due to impeding implementation of ICD-10 and the spate of on-going EM inventions and enhancements. The ever-shrinking reimbursement pool in EM forces every emergency clinic to focus on revenue cycle maximization strategies or face extinction.

Are you perplexed and in a dilemma how to keep in touch with frequent changes codes and related modifiers ?

Do not worry.OutSource or RightSource your EM specific coding worries to MedicalBillingStar.

We, at MedicalBillingStar :

1. Are well versed in the intricacies of EM specific coding services, with many satisfied EM customers across the US.
2. Can extricate you from this problematic scenario.
3. Are fully conversant with the on-going changes in the EM domain.
4. Ideally positioned to offer guidance and a safe passage for the EM fraternity through the thorn-ridden pathway.
5. In addition as freebies we offer free EMR consultation.We also provide pay for subscription involved in any EMR platform of your choice.We provide free EMR consultation services.

‘Furious Patient’ Encounters: The Mysterious Art of Care – Uncovered !

August 6, 2013 by Ango Mark Leave a Comment

A sullen patient may wreck your whole day !

The majority physician encounters with patients are constructive. Conversely, just as any venture has intricate and challenging customers; doctors also come across their share of exigent patient encounters. However, the kind of encounters faced by the healthcare providers is completely exclusive. Though, the art of communicating with ‘difficult’ patients is quite primitive, in the hectic practice environment, the communication hand-offs between patient and physician can easily be fumbled. Even a single encounter with a sullen patient can spoil your whole day and may even affect your prospective agenda.

A couple of approaches that will make the encounter “worse”

A physician must have comprehensive information of the patients and their problems. With a scanty clinical, personal and social knowledge pertaining to the patient, if a physician approaches an upset patient, it may exacerbate the patient’s mood leading a pointless plight. Usually, if you face a sullen person you may be doing one of the two things:
1. Guard yourself or the person who upset them.
2. Try to “crack their trouble”
These are natural human intuitions and they NEVER WORK and instead aggravate the scene.

Miscommunication – A social faux pas

Though there is a dispute about patient safety and physician liability, in the social and legal milieu, the saddle for “triumphant” physician-patient communication lies ultimately with the physicians. Dr. Dike Drummond has designed a simple, structured communication protocol named “The Universal Upset Person Protocol (UUPP)”, to deal with an upset person rapidly, elegantly, effortlessly and empathetically.
UUPP states that, at any instance of the upset patient – physician tête-à-tête, the patient must express their “feelings first”. They are yearning to be listened and understood, for someone to heed their situation. Thus, you must:
1. Realize – as they are upset.

2. Provide an opportunity for them to elucidate their problem.

3. Empathize their trouble.

4. Plan accordingly to resolve the issue.

UUPP – The coherent communication protocol :

The application of UUPP in your clinical practice will be get you a great surprise to see how swiftly the person pacifies, making you hassle-free for cracking the trouble.

1. Face the upset person before you converse :

The upset person needn’t be a patient as the UUPP works for even colleagues, your life-partner, children and even complete strangers. Take a deep-breath! Follow the script below and experience how it right away defuses the ‘difficult’ encounters.

Despite what/who they are upset with… the distress generally comes in one of two flavors.

1. The person is candidly and verbally revealing the distress.
2. The person is upset and NOT VERBALLY EXPRESSIVE. The person is “seething”. You can spot it out clearly by their non-verbal signals, the body language.

2. Say… “You sound/look really upset.”

3. The upset person will say one of two things :

“You bet I am”

Or “No I’m not … I am ANGRY/DEPRESSED/FRUSTRATED/HURT/SAD/OUTRAGED.”

They may name a different emotion. There is a part of you that will believe you have “made a gaffe” here. You didn’t name the correct emotion! Just let that go.

The simple act of you commenting on their upset … caused them to think and elucidate accurately what they were feeling. That elucidation is the key for venting and moving forward in your discussion.

4. “Tell me about it.” or “Tell me what happened.”

The upset person does not usually vacillate given your invitation. They will take right off into an emotion filled description of what happened. Your job here is simple … LISTEN. Really listen.

Look to understand their perspective here. Muster up as much empathy as you can. lend your hands for them

“Get it all out of their system”.

5. When their description is over… look them in the eyes and say,

“I am so sorry that happened to you” or “I am so sorry you feel this way”.

6. Ask, “What would you like me to do to help you?”,

In general, the upset person will have a particular demand. Observe their emotions and listen warily as they make it and observe whether or not you are ready to do what they want you to. This is your opportunity to observe your boundaries for the next pace.

Sometimes, the upset person will wind up here. They just wanted to be heard and are done now. Thank them for trusting you with their feelings – see step 8 below. You can move ahead to your clinical issues at this point with a clean slate.

7. Tell them what you suggest be done now.

Analyze deeply and make a decision about your willingness to make a specific stroke.

If the upset person has asked you to take a specific action – and you are willing to do it – tell them so.
If the upset person’s request is NOT something you are willing to do – set your borders and communicate them obviously. Tell them you are NOT willing to do what they request and do not stop there. Think about what you are willing to do that will address their upset and tell them what you ARE willing instead. Ask if your proposal works for them. It usually only takes a minute or two to come to a concord here.

8. Thank the upset person for being open with you,

“Thank you for telling me how you really feel… it is imperative to me that we understood each other obviously”.

9. Move ahead…

You have now efficiently “emptied the air” with this patient and you can move on to the clinical reasons for their visit today.

Note:

1.Even though the full UUPP above has 9 steps, the whole protocol conversation may take only 2-4 minutes

2. IF YOU DON’T FOLLOW THE UUPP – and either try to defend or fix the problem up front — you are in for a 20 minute kerfuffle every time … because people really don’t care how much you know until they know how much you care.

YOUR NEXT PACE :

1. PRACTICE – PRACTICE – PRACTICE.
2. Print out this document.
3. Learn it.
4. Perform a “role play” with your friend – Let him play the part of upset person.
5. PRACTICE until you are comfortable with the steps and phrases.
6. USE THE ‘UUPP’ WITH YOUR NEXT UPSET PERSON.

GRAB YOUR BENEFITS :

1. Alleviate your stress levels.

2. Thwart burnouts.

3. Turn into a more influential leader.

Stay chilled and enjoy rest of your day !

Why Inadequacies In Clinical Documentation For Anesthesia ?

July 31, 2013 by Ango Mark Leave a Comment

Bogged Down with Clinical Documentation for Anesthesia using Complex, Tough, and Ever-Evolving Coding Systems ?

Are you unable to accurately and thoroughly document the surgical and anaesthesia processes and use the right combination of billing codes and modifiers for timely and proper submission of medical insurance reimbursement claims ?

Are you experiencing nightmares due to lack of awareness of multiple ranges of anaesthetic reimbursement guidelines adopted by different insurance companies ?

The era of inconsistent, inaccurate and incomplete Anaesthetic Documentation: According to a survey conducted by Academic Health Sciences Centre, Montreal, Quebecmany of the preoperative and intraoperative variables which are important for documentation of anaesthesia are recorded inconsistently and incompletely.

Why the need for Precise and Thorough Clinical Anaesthetic Documentation ?

a• A thorough and precise clinical anaesthetic documentation helps in capturing the right combination of the diagnostic/treatment code coupled to the appropriate modifier to depict the actual surgical scenario under which operations are performed.
b• Such an optimal combination of codes and modifiers, along with justified need for the treatment and approved care, helps in sending the correct medical reimbursement claims to insurance companies for speedy receipt of claims, without denial of claims and need to resubmit and follow up the claims.
c.• The cumulative process results in maximizing revenue and profits.
To survive and prosper, you need to enhance documentation, boost coding accuracy, decrease denials, and safeguard payments.

Why the urgency and criticality ? There are more than half-a-dozen issues :

a• Improvement in anaesthesia documentation is critical, since documentation can make or break up the business of anaesthesia providers.
b• In this economic scenario, anaesthetics have to cope-up ever-increasing patient rush, federal and state health regulatory stipulations, and quality care at affordable costs.
c• On and after October 1, 2014, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the ICD-10 code sets in standard transactions adopted under HIPAA. The HIPAA standard health care claim transactions are among those for which ICD-10 codes must be used for dates of service on and after October 1, 2014. This implies that the in-house billing and coding staffs are aware of these changes.
d• ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.
e• In addition, ICD-10 Procedure Codes (PCs) will only be utilized by inpatient hospital claims as is currently the case with ICD-9 procedure codes.
f• For instance, many carriers have special policies regarding reimbursement for anaesthesia, which are surgical/treatment-specific such as during endoscopy. This needs familiarity with respective insurance companies to ensure that the documentation supports what the insurer requires.
g• There is a need to be up to date with the latest coding guideline, and the ability to pinpoint small differences when the descriptors to some of the most common codes change.

3 Examples of intricacies of accurate, exhaustive clinical documentation :

a• Every detail supporting moderate sedation is crucial, considering how closely insurance companies audit the medical necessity and authorization.
b• Correct calculation of time for which anaesthetic services, including time for which the surgeon is present, and so on, are provided.
c• Assigning the correct add-on code when the anaesthetic service lasts longer than 30 minutes (each additional 15 minutes intra-service time), taking care to match the add-on code with the appropriate base code.

The way out of this impasse :

Relax….and Rest Assured and get rid of your nightmares by outsourcing your documentation, coding and billing worries to MedicalBillingStar, an established, experienced one-shop outsourcing vendor.

Why MedicalBillingStar ?

Anesthesia billing is completely unique compared to other specialties and MedicalBillingStar with a commitment to excellence has been billing for anesthesia practices has been billing for anesthesia practices. We streamline documentation, resulting in more efficient billing, and most importantly, better patient care and engagement which ensures that the necessary data is accurate. We offer a sophisticated customized EHR platform for anaesthesiologists and our solutions facilitate secure distribution of information and shortening the reimbursement cycle for anaesthesiologists by ensuring that all required data is present and complete, thus eliminating claim rejections.

Infographics: Eradicating Impediments In Medical Claims Reimbursements

July 23, 2013 by Paul Martin Leave a Comment

Existing turbulent healthcare industry scenario :

In the current turbulent economy-ridden environment healthcare providers and physicians are not able to precisely and correctly claim the actual reimbursements of expenses incurred for diagnostic and treatment purposes from the insurance agencies, resulting in loss of revenue, profitability, incorrect claims, delayed claims, missing out on claims, the main reason being that they are not fully equipped to provide precise diagnostic and treatment documentation, backed by capturing the correct medical codes for medical billing. The physicians do not have the time to oversee capturing the correct medical codes and medical billing procedures as they have to focus on their core competency of diagnosis and treatment as first priority.

Vital issues compounding the problems :

Healthcare professionals are constantly under pressure due to increased patient/financial constraints and regulatory pressures, forecasting a doomsday for medical services. This situation is worsened further due to federal regulations that advocate improved, affordable healthcare services without comprising on quality issues even under the present economic scenario where the inputs for provision of healthcare services are experiencing spirally increased costs. To further complicate the issue, in-house administrative personal are not inadequately trained, inexperienced and lack the requisite expertise in medical coding and billing, as well as thorough and accurate clinical documentation.

The physicians would like to spend most of their time and efforts by focusing on core issues of diagnosis and treatment, rather than diverting their resources and energies over the nuances of managing and monitoring their to maximize revenue. Rather than have in-house medical coding and billing services, it pays to opt for outsourcing or right sourcing the billing services to established and experienced vendors. There is a dire need for in-house analysis of existing problems, solutions, future trends, and remedial measures.

The situation will further worsen in the near future since presently health care reforms are under way with focus on affordable health coverage and quality.

Medical Reimbursement Problems faced by Health Providers :

Insufficient knowledge or experience in medical coding and billing
Lack of training in medical coding and billing
Physicians using In-house medical coders and billers have to feel the consequences by struggling with inexperienced coders straight out of college
These billers and coders fail to cope up with evolving coding and billing guidelines, for medical procedures, and stay abreast with the latest procedures
Nightmares of lost revenue and unpaid bills

Lost revenue opportunities :

Physicians tend to miss opportunities to maximize medical reimbursements from the insurance companies.Lost revenue due to various factors includes:
Undercoding level of treatment,
Omitting modifiers,
Submission of medical reimbursement claims without the requisite documentation required to support the reimbursements.
Wastage of resources in determining and tracking reasons for claims rejected, besides finding out claims missed or under claimed.

The pathway to maximum reimbursement :

Out sourcing or better known as “Right sourcing” the medical billing and coding, clinical documentation, claims processing, EMR services to professional one-stop third party vendors results faster, precise and complete reimbursement of medical claims, boosting up revenue and profits.
Besides assigning the right codes for medical services the outsourcing vendor provides specialty specific coding services using experienced and AAPC credentialed coders on board.
The vendor is conversant with the significance of coding for the technical and professional components of a medical service, place of service codes, e/m codes, revenue codes, and when claims need to be bundled or unbundled.Compliance with all medical coding systems such as ICD, CPT and HCPCS ensures that working with such vendor is a smart option.

Remedial Measures :

Wise,prudent, and strategic to partner established third party vendors such as MedicalBillingStar who have long-standing expertise, experience in dealing with state-of-the-art coding and billing services to a wide range of categories in the US medicare industries.
Healthcare and medical units, irrespective of whether they are small, medium, or large, stand to experience hassle-free boost-up of medical reimbursements, without the nightmares of returned claims, missed-out claims, and piling up of rejected claims, and efforts to resubmit claims.
MedicalBillingStar closely follows the on-going trends in medical coding and billing and medical insurance claims processing methodologies.

The AMA Suggests That Physicians Should Focus On Billing. Are You?

July 10, 2013 by Ango Mark Leave a Comment

Are you losing out on billable dollars ?

This is not the best time to be a healthcare provider! Financial constraints and regulatory pressures are giving physicians, sleepless nights. Doomsayers have crawled out of the wood works to proclaim that medical practices are going to fold up and die.

It is certainly not like healthcare is circling the drain hole. But it is essential that medical practices up their game to stay afloat.

Still stuck with a payment contract that is five years old ?

The major mistake that healthcare practices make is to get paid much lower than the services they provide. Nobody likes getting on the phone and haggling with insurers. But what has to be done has to be done! Frequently negotiating reimbursement contracts will go a long way in increasing revenue.

Thorough claim analysis and evaluation of top paying CPT codes every three months can prevent and clot the bleeding.

It is okay to discuss money with patients !

Do you feel delicate when discussing about money with patients? Instead of dillydallying be forthright with your patients about treatment costs and payment options. Give them a lowdown on what and how much the insurer will cover.

A lot of patients promptly sue their doctor the minute they receive a bill. Discussing about payment prior to a medical procedure will prevent heartaches and heated arguments.

Don’t rely on straight- out of a- can solutions…

Most EMR/EHR systems come with coding and billing features. But no matter how loaded your system is, don’t lean on it completely. There are certain factors such as duration of treatment or the extent of injury that play a crucial role in increasing reimbursement. Middle of the road coding isn’t going to cut it anymore.

Why work just eight hours ?

As pressures mount and operational costs skyrocket, outsourcing has become a viable option. It makes a lot of sense to work with a billing company that works 24 hours. You not only process claims faster you can clear revenue backlogs.

Furthermore it is a nice feeling to walk in to your practice the next day knowing fully well that your biller has transmitted your claims to the insurer. And that now, finally, the accent will once more be on patient care.

ACO Wars – Pioneer vs Shared Savings Programs

July 3, 2013 by Ango Mark Leave a Comment

Well, it is not a war in the strictest sense of the term, but it does denote the recent developments in the ACO or Accountable Care Organization scene where many Pioneer ACOs have been opting out of the program due to difficulties in meeting the targets and the high risks involved. About 25% of the Pioneer registered Accountable Care Organizations are in the process of exiting the program and joining the lower-risk option, the Shared Savings Program. CMS had this to say about the fallout :

“We’re encouraged that these organizations want to continue in programs that promote better care at lower costs, we fully anticipated that as these programs get up and running, some organizations would shift between models.”

Health Reforms & ACOs

For those of you, who have been too busy to register what an ACO exactly is, it is a category of CMS program, which is part of the government health reform, which includes others like Patient Centered Medical Home, Medical Neighborhood, Health Home, etc. The reforms themselves consist of three main components, which is a superset of any practice models. They are :

a. Care Delivery Reforms.

b. Payment Reforms.

c. Health and Healthcare Community Reform.

ACO is a model which is, to quote a popular definition, “an organization, virtual or real that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs.”

As the above definition clearly points out, an ACO platform is expected to stimulate more integrated care for the patients, which would ultimately result in quality improvements and healthcare cost reduction. Also, in these programs the ACO gets a share in the costs ultimately saved.

Pioneer vs Shared Savings Programs

SSP and Pioneer were two landmark ACO programs created by CMS. The latter has a slightly complex format, which takes into consideration organizations that already have some experience in providing coordinated care.

The Main Differences between the two are:

1. SSP has two payments tracks and it is upto to the ACO to choose either the non-risk sharing one (which has less cost savings share) and the risk-sharing track (which has higher cost savings share but at the same time there are possibilities of losses upto even 60%).

2. The Pioneer utilizes a trending methodology that, all other things being equal, produces a slightly higher benchmark than the SSP for high-cost areas.

3. The SSP will need to cater to at least 5,000 Medicare fee-for-service beneficiaries, whereas the Pioneer needs to service 15,000.

4. The Pioneer program importantly includes a clause that 50% of Pioneer ACOs revenues should come from participating in “risk” contracts with other non-CMS (private) payers.

The Significance of events such as the above

Republicans have been ardently opposing the health reforms (which is really an attempt for universal healthcare). The recent refusal by the National Football League to team up with the government to promote ObamaCare has been touted as some sort of vindication for their stance. Also, the refusal of some states to adopt the Medicaid expansion plan and the setting up of online HIE, to realize the goal of “healthcare for all” , is seen as further supporting evidence. And the above developments in the Pioneer ACO scene is construed by some health reform detractors as the “straw that will break the ACO camel’s back”.

MedicalBillingStar : A Voice of Sanity

With a decade of hands-on experience in servicing over 500 clients when it comes to the RCM Cycle, MedicalBillingStar always endeavors to float above the cacophony of healthcare gossips and half-truths, to provide their medical billing and coding clients with information that is relevant, besides of course catering to their entire RCM workflow. We are aware of the impact that ACO’s will have on payment models, the changes from which ultimately have to be incorporated into the RCM process. Thus, we keep abreast of the latest happenings in the payment model scene. Meanwhile you may call MedicalBillingStar at 877-272-1572 or visit our website at www.medicalbillingstar.com if you any questions about any of the above or the Medical Billing/Coding processes in general.

A Few Survival Strategies For Healthcare CFO’s To Handle 2014

June 20, 2013 by Ango Mark Leave a Comment

Time for healthcare CFO’s to step up their plate !

2014 is going to be a year of change. Federal mandates, financial constraints and heavy penalties for non –compliance is going to make 2014 a challenging, tumultuous year. It is time to up the game to ensure medical practices don’t crumble under pressure. And as always it is the man at the helm who needs to up the game!

Focusing on wellness programs can help you save on taxes !

The PPACA requires all healthcare organizations to review the wellness plans of all full time employees. Choosing a wellness plan that is highly deductible can be a major tax saver. CFOs will have to examine the current coverage plans.

And freeze in on a wellness plan that works both for their employees and also saves on taxes. This could well be the major priority of healthcare CFOs in 2014.

Systems to record the quality of care…

The healthcare landscape is undergoing a period of transition. From volume based payments. To a model that is based on the quality of care and patient outcomes. It is essential that CFO’s implement systems and upgrades to report and measure clinical variations. Maintaining, longitudinal health records that are detailed and contain data across the care continuum, is important.

Will your clinical documentation cut it ?

Do you maintain pristine clinical documentation ? If yes you are lucky. If, like a majority of health care providers your answer is, no, then it’s time you upped the ante. Review your revenue cycle that coordinate with coders and physicians to ensure more accurate and updated clinical documentation.

Analyze every phase of the RCM to see where you can reduce costs. Have your billing team give a detailed report of key financial metrics.

Outsourcing can be a huge cost saver !

Reducing the number of full time employees can help you cut back on costs. But this is a move that has to be taken after weighing in the pros and cons.

Here’s a quick presentation for CFO’s to handle the practice.

Forget The Incentive. Can Your Practice Escape MU Penalties?

June 10, 2013 by Ango Mark Leave a Comment

How do you avoid MU penalties ? There is just one way, demonstrate meaningful use . The primary worry of all healthcare providers is missing out on incentives. But taking steps to avoid the fast approaching penalties should be the top most priority right now. It is time for physicians to get in on the ground floor and work towards MU.

Working hand in hand with patients !

To, meet compliance deadlines, it isn’t enough, that you adopt an EHR, and optimize, your, workflow. Remember that it all boils down to just one thing, the quality of care you provide patients. Explore better ways of working with your EHR to avoid nasty payment cuts and penalties.

Eligible professionals, who are going to demonstrate meaningful use to avoid payment adjustments in 2015, must kick start their EHR reporting period by July 2014. You will have to work at breakneck speed to reach the finishing line on time.

Ramping up patient portal efforts…

Under stage two of Meaningful Use patients should be able to view their data, download it and be able to transmit it. Do you know that a functional patient portal can help you meet, 3 core objectives and 4 menu objectives? That it could be the easiest way of meeting the patient engagement criteria?

Though a patient portal can be available in the provider’s website or function as a stand -alone online application. A patient portal that is integrated in to your EHR can improve functionality and ensure data security.

Patient engagement the big “gotcha” !

Laura Kreofsky the principal advisor for Impact Advisors predicts that patient engagement and public reporting are going to be the major stumbling blocks for physicians. Make sure you option for an EHR with a robust patient portal. If you are an EHR user insist that your vendor provides you with a fully functional patient portal.

The payment cuts for physicians who’ve missed the boat…

Source:Practice fusion

« Previous Page
1
…
5
6
7
8
9
…
13
Next Page »

Join The webinar

Lisa Maciejewski-WestCMC, CMOM, CMIS, MCS-P