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INCREASING PROFITS

The physician enterprise model: a non-employment alternative

By John W. McDaniel bio Hospitals are seeking new and innovative ways to affiliate with physicians that differ from tactics used in the 1990s, These new relationships involve a more formal type of relationship with physicians, which might reflect lessons learned through previous less‐than‐satisfactory relationships. Most hospitals have physician integration strategies as a part of their long‐range plans, but because physicians employed by hospitals lose approximately $190,000 per year, hospitals and health systems must explore alternatives to physician affiliation aside from the traditional employment model. Beyond employment Affiliation is sought for various reasons. Large hospitals seek a wider reach into communities, while small and rural hospitals seek help with physician recruitment, which has been troublesome over the past years due to 84% of senior medical residents desiring to practice in… . . . read more.

BILLING & CODING

Updated info for Pfizer-BioNTech vaccine

On Dec. 11, 2020, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID‑19 Vaccine for the prevention of COVID-19 for individuals 16 years of age and older. Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of authorized use. During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review the CMS updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free. Related links: CMS COVID-19 Provider Toolkit CMS COVID-19 FAQs CDC COVID-19 Vaccination Communication Toolkit for medical centers, clinics, and clinicians FDA COVID-19 Vaccines webpage

CODING

Impact of reimbursement and compliance to WRVU-based compensation

By John McDaniel bio All physician contracts including any form of WRVU based compensation may need to be reviewed and probably amended because of the increase in WRVUʹs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased physician/provider reimbursement since the WRVUs for these codes have been significantly changed. Indeed, this increase in the WRVU component will certainly affect physician compensation. While the major commercial payers have not yet announced their intention to utilize the 2021 E&M codes, those decisions will greatly impact both provider reimbursement and WRVU utilization. It should be noted… . . . read more.

WRVUs

The new paradigm for physician compensation: payment for value/quality v. volume

By John McDaniel bio How will physician compensation arrangements be impacted by quality incentive payments with respect to determining Fair Market Value and commercial reasonability? The enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) in November 2016 set forth future options for payment from Medicare, those being participation in the Merit‐Based Incentive Payment System (MIPS) or participation in one or more Alternative Payment Models (APMs). Both models will likely change how physicians are compensated. MIPS requires participating Medicare providers to be subject to payment adjustments, both positive or negative, based on their performance as determined by four measures, those being (1) quality, (2) advancing care information, (3) clinical practice improvement activities and (4) cost. While MIPS was designed to provide incentives for both quality and value improvements, it… . . . read more.

Medicare

New deadline of Dec. 13 to update APM Incentive billing info

Is your office among the clinicians that need to verify Medicare billing information by Dec. 13 in order to receive payments? The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything. CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain: Who is eligible to receive an APM incentive payment in 2020 How CMS determines your 2020 APM… . . . read more.

CODING

Impact of 2021 evaluation and management coding changes to WRVU based physician compensation

By John McDaniel bio As you may know, all physician contracts which include any form of WRVU based compensation will need to be reviewed and probably amended due to the increase in WRVUs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. We recently conducted an assessment for one of our hospital clients which showed the ʺunintended consequencesʺ of increased compensation to the physicians/providers and the resultant impact to fair market value standards. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased reimbursement since the WRVUʹs for these codes have increased. Indeed, the increase in the WRVU component will certainly affect physician compensation… . . . read more.

BILLING & COLLECTIONS

Retaining patients as insurance landscape shifts

By Kerri Lenderman bio Walmart’s July announcement that they plan to start selling Medicare insurance should have resonated with America’s physicians as more than an interesting headline to interrupt a summer of coronavirus news.  Indeed, it should be a wakeup call and a reminder that unsettling and unconventional forces with deep pockets and consumer brand loyalty are forming a tsunami of disruption in how insurance will be marketed and influenced for years to come. Competition for Medicare market share has always been steep.  Historically it manifested in the form of aggressive health plan marketing campaigns from insurers and brokers, all trying to lock in Medicare eligibles – especially people approaching age 65.  Selecting a plan is overwhelming with dozens of plan options to choose from in a given market, including… . . . read more.

QPP

Deadline Oct. 5 to ask for MIPS targeted review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request the Centers for Medicare & Medicaid Services (CMS) to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5, 8 p.m…. . . . read more.

REIMBURSEMENT

Your office will be paid for counselling patients to self-isolate at time of COVID-19 testing

CMS and the Centers for Disease Control and Prevention (CDC) have announced that payment is available to physicians and health care providers to counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested and prior to the onset of symptoms. The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic, and asymptomatic individuals. Education on self-isolation is important as the spread of the virus can be reduced significantly by having patients isolated earlier while waiting for test results or symptom onset. The CDC models show that when individuals who are tested for the virus are separated from others and placed in quarantine there can be up to an 86 percent reduction in the transmission of the virus, compared to a 40 percent decrease in… . . . read more.

PANDEMIC

Protecting your medical practice during uncertain times

By John W. McDaniel bio Given the recent disruption and decreased demand for physician office services, coupled with the foreboding predictions associated with the COVID-19 pandemic, both hospital- affiliated and private medical practices are having to adjust their operations in order to provide billable patient care services while salvaging the cash flow/liquidity of the practice. Indeed, physicians have been slow to adopt telemedicine as an essential adjunct service; yet, the current external environment beyond our control has caused physicians to respond and explore ways to optimize operational changes in terms of modifying the traditional business model of physician practices in order to be financially viable now and in the future. The greatest change has resulted in realizing the benefits of telemedicine as physicians are discovering the benefits of performing patient assessments… . . . read more.


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