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BILLING

Newly proposed Medicare Part B Physician Fee Schedule contemplates Making COVID-19 telehealth changes permanent

On July 13, 2021, CMS published its proposed physician fee schedule rule for FY 2022. One of the key items is the proposal to make the temporary change allowing Medicare providers to deliver healthcare services via telehealth a permanent part of Medicare Part B. The Proposed Medicare Changes During the public health emergency (PHE), Congress added the home of the beneficiary as a permissible originating site for telehealth services for the purposes of diagnosis, evaluation or treatment of a mental health disorder. In addition to updating the fee schedule, the proposed CY2022 rule would allow certain services added to the Medicare telehealth list to remain on the list until the end of December 2023. This would allow CMS to continue to evaluate whether the temporary expansion of telehealth services adopted… . . . read more.

YOUR CAREER

Listening as if you mean it: an important managerial skill

By Lynne Curry It’s easy to give an excuse for not listening. You don’t have time; the speaker rambles or bores you. You already know what you’re about to hear. It’s harder to admit you’re a poor listener—isn’t listening something we do all the time? No. The opposite proves true. Most of us find it hard to listen to someone who has something to say we don’t want to hear. We instinctively interrupt, tune out, or wait until the speaker finishes and then say what we wanted to say in the first place. The result—we miss hearing information we later wish we’d heard; we fall easily into “yes…but” arguments in which neither you nor the other person comes to terms with each other’s viewpoint. We sacrifice opportunities to draw out… . . . read more.

Employment Law Update

Making faces doesn’t count as retaliation

By Mike O’Brien Not every negative consequence amounts to retaliation In asserting a claim for retaliation, an employee must prove he or she suffered a “materially adverse action.” But that probably doesn’t include someone “making faces” at you. In Fisher v. Bilfinger Industrial Services Inc., the employee alleged that his supervisor retaliated against him by (among other things) “making faces at him.” The First Circuit Court wasn’t impressed. The court noted that “adverse employment actions” are things like “discharges, demotions, refusals to hire, refusals to promote, and reprimands.” “Making Faces,” on the other hand, amounts to “a frivolous claim that does not implicate Title VII.” In the litigation world, we call this a “bench slap.” You can read the full decision here. More limits on non-competes . . . eventually On July… . . . read more.

YOUR CAREER

Potential for disaster when you serve on a volunteer board

By Lynne Curry Sometimes you take on work for which you aren’t paid—because it matters, or because you’ve been talked into it. Perhaps you serve on the board of a non-profit healthcare corporation, offering your experience and knowledge as a medical office manager. Possibly you run for your condo association’s board of directors because you want some control over the condominium unit in which you live. Despite the zero pay, you occasionally face situations that require hard work and take every ounce of skill you possess. Recently, I helped a community health clinic 11-person board of directors when they found themselves petitioned by angry former employees and upset community members. They hadn’t expected the depth of allegations against the clinic or its top two leaders, nor to find their clinic… . . . read more.

QPP

First snapshot ready for APM status and data

The Centers for Medicare & Medicaid Services (CMS) has updated its Quality Payment Program Participation Status Tool based on the first snapshot of Alternative Payment Model (APM) data. The first snapshot, posted July 8,  includes data from Medicare Part B claims with dates of service between Jan. 1, 2021 and March 31, 2021. The tool includes 2021 Qualifying APM Participant (QP) status and Merit-based Incentive Payment System (MIPS) APM participation status. To learn more about how CMS determines QP and the APM participation status for each snapshot, visit the APM Determination webpage on the QPP website. What does QP status mean? If you qualify as a QP, this means you are: Eligible for the 5% APM incentive bonus; Eligible for APM-specific rewards; and Exempt from participating in MIPS. How do I check my QP… . . . read more.

BILLING

New federal rule to protect consumers from surprise medical bills

The Biden-Harris Administration has announced a rule to protect consumers from surprise medical bills. The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans. “No patient should… . . . read more.

WORKPLACE SAFETY

FDA reverses course on healthcare worker re-use of N95 masks

For decades, the N95 filtered mask has been a vital piece of personal protective equipment for frontline medical workers. But for months, shortages of that precious item which was previously taken for granted left countless health care workers defenseless from exposure to the coronavirus. The good news is that the N95 shortages have finally abated, with surplus stockpiles enough to last three to 12 months. As a result, federal regulators are beginning to unwind some of the health and safety shortcuts they authorized labs to take to deal with the lack of adequate N95 supplies. The FDA calls for ending N95 recycling & sharing National Institute of Occupational Safety and Health (NIOSH) standards dictate that N95 masks be used once and then thrown away. But as an emergency response to… . . . read more.

MANAGING STAFF

Staffers push back about returning to work

By Lynne Curry Question: We’re getting enormous pushback from our staff to an email we sent out stating that billing and clerical employees need to return to the workplace. At the same time, our organization can’t survive if we let all the employees who want to work from home do so. It’s not fair to our patients or the employees who show up at work. Further, when I call those who allegedly work full time but at home during the workday, they often let slip the fact that they’re not working. I’ve been told, “let me turn down the TV” or “sorry I didn’t answer right away, I was out in the garden.” Those who want to work from home insist they’re afraid they’ll catch COVID if they return to… . . . read more.

HIPAA

Could your organization’s website reveal your HIPAA non-compliance?

By Danika Brinda Did you know that your organization’s website can reveal to the world that you are out of compliance with HIPAA? A quick look at your organization’s website could reveal to a HIPAA auditor that your organization is struggling with HIPAA compliance. Wondering what I am referring to? The Notice of Privacy Practices! The regulations state that your organization must ensure that the most current version of your Notice of Privacy Practices is posted on the organization’s website (if one exists). Here is the specific language of the regulations: CFR 164.520(c)(3)(i) – A covered entity that maintains a website that provides information about the covered entity’s customer services or benefits must prominently post its notice (of privacy practices) on their website and make the notice available electronically through their website. Go… . . . read more.

INCREASING PROFITS

Denial management: the missing ingredient in revenue cycle management

By John McDaniel The blueprint for effective Revenue Cycle Management (RCM) is complex in today’s healthcare environment. When we map out the RCM process, it includes the following steps: Patient scheduling and registration Insurance eligibility and benefit verification Collection of copayments and deductibles at time of service Claims submission Remittance processing Denial management Back‐end patient collections Denial Management Implementing an effective and efficient process for managing claim denials is likely the single most important action a healthcare organization can make to affect its revenue cycle. Denial management is by no means a simple process; in fact, it is often extremely complex. According to the American Academy of Family Physicians, the average claim denial rate across the healthcare industry is 5 to 10 percent, varying between specialties. With the average cost… . . . read more.


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