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Home » topics » Billing and collections
INCREASING PROFITS

Track these 5 metrics for practice profitability

January 6, 2023 by

By Mike Rigert “It was the best of times, it was the worst of times … , ” wrote author Charles Dickens in his classic novel, “A Tale of Two Cities.” While it’s certainly not the worst of times for most healthcare practices (that honor likely went to 2020-2021), things could always be better, right? You’re likely still dealing with the impacts of rampant inflation and ongoing short staffing, among other things. Despite these setbacks, there’s clear opportunities to move your practice forward to improve both production and productivity to help you reach your financial goals. It all goes back to numbers—the key performance indicators (KPIs) that determine whether your practice sinks or swims. Some metrics are more important and vital to the success of your practice than others. We’ve outlined five… . . . read more.

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HIPAA

Proposed rule would standardize how to send health care attachments

December 26, 2022 by

It might get easier for your medical office to send healthcare attachments and electronic signatures. The Centers for Medicare & Medicaid Services (CMS), has issued a proposed rule, “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P).” If finalized, the proposed rule, would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. The modifications to the HIPAA transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The is a part of ongoing efforts to… . . . read more.

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COVID-19

Jan. 3 deadline for MIPS Extreme and Uncontrollable Circumstances application

December 15, 2022 by

The deadline to submit a MIPS EUC Exception application for the 2022 performance year is 8 p.m. ET on Jan. 3, 2023. If you believe you’ve been affected by an extreme and uncontrollable circumstance (such as the public health emergency triggered by the COVID-19 pandemic), you can apply whether reporting traditional MIPS or the APM Performance Pathway (APP). MIPS eligible clinicians, groups, and virtual groups may submit an application to reweight any or all MIPS performance categories if they’ve been affected by extreme and uncontrollable circumstances that impact these performance categories. Alternative Payment Model (APM) Entities may submit an application but are required to request reweighting for all performance categories. Beginning in the 2023 performance year, clinicians will also have the option to report via the MIPS Value Pathway (MVP)s framework instead of traditional MIPS. Learn more: CMS’s Current Emergencies Medicare IFC: Revisions in Response… . . . read more.

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CODING & BILLING

CPT update for COVID-19 boosters adapted to omicron

September 6, 2022 by

The American Medical Association has announced an update to Current Procedural Terminology (CPT)®, that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech. The updated boosters are adapted for the BA.4 and BA.5 Omicron subvariants and the original coronavirus strain in a single dose. Four of the eight CPT codes (91312, 91313, 0124A and 0134A) are effective for use immediately as the U.S. Food and Drug Administration (FDA) has authorized Moderna’s new COVID-19 booster in individuals 18 years of age and older and Pfizer-BioNTech’s new COVID-19 booster in individuals 12 years of age and older. Four CPT codes (91314, 91315, 0144A and 0154A) will be effective for use on the condition that the FDA authorizes Moderna’s new COVID-19 booster in individuals 6 years through… . . . read more.

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BILLING & CODING

Telehealth policy to change after the COVID-19 public health emergency

September 1, 2022 by

The COVID-19 public health emergency has been extended to Oct. 13. Of particular interest to medical practices is the continuation of telehealth flexibilities, which will expire at the end of the public health emergency. US Department of Health and Human Services Secretary Xavier Becerra officially renewed the declaration in mid-August. The emergency declaration has been in place since January 2020, and the latest renewal came as the Omicron offshoot BA.5, the most contagious variant yet, continues to stake its claim in the US. Daily case rates, though vastly undercounted, are the highest they’ve been in months, as are COVID-19 hospitalizations and deaths. Data published in August by the US Centers for Disease Control and Prevention shows that more than half of the country’s population lives in a county with a… . . . read more.

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BILLING & COLLECTIONS

Medicare covering OTC COVID-19 tests

April 4, 2022 by

Starting this week and through the end of the COVID-19 public health emergency (PHE), Medicare covers and pays for over-the-counter (OTC) COVID-19 tests at no cost to people with Medicare Part B, including those with Medicare Advantage (MA) plans. In addition to helping prevent the spread of COVID-19, the goal is to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements. What’s covered Eligible providers or suppliers can distribute U.S. FDA-approved, authorized, or cleared OTC COVID-19 tests to patients enrolled in Part B, including those enrolled in MA plans. Patients who only have Medicare Part A can get free OTC COVID-19 tests through other government-led programs, like covidtests.gov, which operates through the United States Postal Service (USPS). Or,… . . . read more.

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PATIENT ACCESS

AMA asks Congress to fix Medicare physician payment system

March 28, 2022 by

The American Medical Association (AMA) has warned congressional leaders that the Medicare Payment Advisory Commission (MedPAC) report sent to Congress in mid-March contains flawed analyses that would imperil patient access to high-quality care. The MedPAC report recommended a continuation of the freeze in Medicare physician fee payments but ignores a host of trailing indicators, none more obvious than the impact of the COVID-19 pandemic on physician practices. In 2020, there was a $13.9 billion decrease in Medicare physician fee schedule spending as patients delayed treatments. Burnout, stress, workload, and fear of COVID infection are leading one in five physicians to consider leaving their current practice within two years. The letter to Congress includes a chart—based on an analysis of data from the Medicare Trustees—that shows Medicare physician payment has been… . . . read more.

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MOM WEBINAR

Learn about changes and updates to telehealth

March 25, 2022 by

There’s a lot you need to know about telehealth. That’s why Medical Office Manager is offering a webinar, Telehealth—What Managers Need to Know, on April 6. It’s free to Medical Office Manager members. Presenter Jen Bell of Karen Zupko and Associates will give you the tools and knowledge you need to comply with new telehealth regulations. Meanwhile here is Jen’s update on telehealth changes to early 2022. POS 10 Telehealth Provided in Patient’s Home Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. Home may be defined to include temporary lodging (hotels, homeless shelters) and patient travels of short distance from the exact… . . . read more.

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FREE WEBINAR FOR MOM MEMBERS

What managers need to know as telehealth flexibilities carry on

March 23, 2022 by

Telehealth rules that were loosened during the pandemic are likely to stay that way for awhile. President Biden signed the Consolidated Appropriations Act of 2022 into law last week. Included in the law is an extension to some telehealth flexibilities for an additional five months (151 days) after the end of the current public health emergency (PHE). Flexibilities that will be extended include: Originating site and geographic location waivers—this allows patients to have a telehealth visit from their home (or another site) not just CMS designated originating sites Extends temporary qualifying providers (e.g., physical therapists, occupational therapists, speech language pathologists, audiologists, and dieticians) the option to furnish distant site services Mandates CMS to continue covering audio-only telehealth visits for Medicare beneficiaries Delays the in-person visit requirement for mental telehealth visits… . . . read more.

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BILLING

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

July 22, 2021 by

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.

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